V-112.4: Infection transmission risk from kidney donors with active Hepatitis B: A systematic review and meta-analysis of observational data

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Aims: Potential kidney donors with active hepatitis B (HBV), defined as positive surface antigen (HBsAg) and/or nucleic acid test (NAT), are usually declined for HBsAg-negative recipients. With vaccination and antivirals, transplantation could be safe. We aimed to quantify the transmission risk. Methods: Systematic review and meta-analysis, searching MEDLINE for “hepatitis B” and “kidney transplantation”. We included cohorts of kidney transplantation from donors with active HBV to HBsAg-negative recipients. Transmission was defined as HBsAg or HBV NAT positivity post-transplant. Transmission proportions were pooled using meta-analysis with random effects, employing Freeman-Turkey double arcsine transformation and exact 95% confidence intervals. Results: After screening 3,143 records, 21 cohorts were included. Among 606 donors, most were living (57%); all had positive HBsAg but most had negative NAT (55%). Among 614 recipients, most had protective surface antibody (HbsAb, 86%) titres, and many were core antibody positive (48%). Prophylaxis varied in strategy (8 cohorts universal, 6 none), type (hepatitis B immunoglobulin 37% recipients, antivirals 44%) and duration. There were 26/614 HBV transmissions (4.2%), less common where all recipients had protective HBsAb (1.3%) or all donors had negative NAT (0.6%). There were 3 deaths due to HBV (0.5%): all occurred off prophylaxis (one never given, one post short course, and one non-compliant). The pooled transmission rate was 0.8% (95%CI: 0.00-3.8%, Figure 1) although there was substantial heterogeneity between studies (I2=53.9%). This may be explained by differences in case ascertainment, prophylaxis strategies or donor/recipient factors.Conclusion: Given low transmission rates, donation could be considered from kidney donors with active hepatitis B in controlled circumstances.

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