Hepatitis B Virus Donor Positive to Recipient Negative (D+/R−) Heart and Lung Transplantation: Analysis From the Organ Procurement and Transplantation Network

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INTRODUCTION: In nonendemic areas, transplantation from donors with hepatitis B virus (HBV) to recipients without HBV (D+/R-) has been proposed to expand the donor pool; however, data are limited. We aimed to evaluate the epidemiology of HBV in thoracic organ donors, assess HBV-related thoracic organ nonuse, and determine the impact of HBV D+/R- in recipient outcomes. METHODS: Adult first-time heart and lung transplant recipients with negative hepatitis B surface antigen (HBsAg) and HBV nucleic acid testing (NAT) were identified through the Organ Procurement and Transplantation Network between January 2004 and December 2022. Multivariable Cox regression models were built to assess the relationship of donor HBV status with death and graft failure. RESULTS: Our final cohort included 64,514 thoracic organ transplant recipients, 53 HBV D+/R- (0.1%) versus 64,461 (99.9%) HBV D-/R-, including 34,547 (53.5%) heart and 29,967 lung (46.5%) transplants. Donors with positive HBsAg or HBV NAT tests represented 0.31% of the donor pool. There were no reported cases of thoracic organ nonuse due to hepatitis, nor were there differences in the rates of HBV-NAT or HBsAg positivity in used versus nonused thoracic organs. In multivariable modeling, HBV D+/R- was not associated with increased hazard of death (adjusted hazard ratio (aHR), 0.80 [95% CI, 0.30-2.13], p = 0.652) or graft failure (aHR, 0.73 [95% CI, 0.27-1.93], p = 0.522) at 1-year. CONCLUSIONS: HBV D+/R- thoracic organ transplantation does not appear to have a deleterious impact on recipient or graft survival. However, more data are needed to determine the long-term risk of donor-derived HBV infection and define the optimal management strategies.

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