Donor Derived Hepatitis B Virus Infection: Analysis of the OPTN/UNOS Ad Hoc Disease Transmission Advisory Committee.

Theodoropoulos, Nicole M; La Hoz, Ricardo M; Wolfe, Cameron; Vece, Gabriel; Bag, Remzi; Berry, Gerald J; Bucio, Jamie; Danziger-Isakov, Lara; Florescu, Diana F; Goldberg, David; Ho, Chak-Sum; Lilly, Kathleen; Malinis, Maricar; Mehta, Aneesh K; Nalesnik, Michael A; Sawyer, Robert; Strasfeld, Lynne; Wood, R Patrick; Michaels, Marian G

Hepatitis B virus (HBV) can be transmitted from organ donor to recipient, but details of transmission events are not widely published. The Disease Transmission Advisory Committee (DTAC) evaluated 105 cases of potential donor derived transmission events (PDDTE) of HBV between 2009-2017. Proven, probable or possible transmission of HBV occurred in 25 (23.8%) cases. Recipients of liver grafts were most commonly infected (20 of 21 exposed recipients) compared to 9 of 21 exposed non-hepatic recipients. Eleven of 25 donors were HBV core antibody (HBcAb) positive/HBV surface antigen (HBsAg) negative and infected 8/20 recipients. Of the 10 liver recipients and 1 liver-kidney recipient who received organs from these donors: 6 were not given antiviral prophylaxis, 2 developed infection after antiviral prophylaxis was discontinued, 2 developed HBV while on lamivudine prophylaxis, 1 was on antiviral prophylaxis and did not develop HBV viremia or antigenemia. One recipient of a HBcAb positive/HBsAg negative kidney developed active HBV infection. Unexpected donor-derived transmission of HBV was a rare event in reports to DTAC, but was often detected in the recipient late post-transplant. Six of 11 recipients (54.5%) of a liver from a HBcAb positive donor did not receive prophylaxis; all of these were potentially preventable with the use of anti-viral prophylaxis.