The Outcomes of Kidney Transplantation in Hepatitis B Surface Antigen (HBsAg)-Negative Recipients Receiving Graft From HBsAg-Positive Donors: A Retrospective, Propensity Score-Matched Study

The outcomes of kidney transplantation (KT) from hepatitis B surface antigen-positive [HBsAg(+)] donors to HBsAg(-) recipients remain inconclusive, possibly due to substantial differences in methodological and statistical models, number of patients, follow-up duration, hepatitis B virus (HBV) prophylactic regimens and hepatitis B surface antibody (anti-HBs) levels. The present retrospective, longitudinal study ( NCT02044588) using propensity score matching technique was conducted to compare outcomes of KT between HBsAg(-) recipients with anti-HBs titer above 100mIU/mL undergoing KT from HBsAg(+) donors (n=43) and HBsAg(-) donors (n=86). During the median follow-up duration of 58.2 months (range 16.7-158.3 months), there were no significant differences in graft and patient survivals. No HBV-infective markers, including HBsAg, hepatitis B core antibody, hepatitis B extracellular antigen and HBV DNA quantitative test were detected in HBsAg(+) donor group. Renal pathology outcomes revealed comparable incidences of kidney allograft rejection while there were no incidences of HBV-associated glomerulonephritis and viral antigen staining. Recipients undergoing KT from HBsAg(+) donors with no HBV prophylaxis (n=20) provided comparable outcomes with those treated with lamivudine alone (n=21) or lamivudine in combination with HBV immunoglobulin (n=2). In conclusion, KT without HBV prophylaxis from HBsAg(+) donors without hepatitis B viremia to HBsAg(-) recipients with anti-HBs titer above 100mIU/mL provides excellent graft and patient survivals without evidence of HBV transmission. This study demonstrates that hepatitis B surface antigen (HBsAg)-negative recipients with hepatitis B surface antibody titer above 100 mIU/mL who received a kidney allograft from HBsAg-positive donors have favorable longterm kidney allograft survival without hepatitis B viral transmission.