Dr Katherine Richards1,2, Prof David Gracey1,2, Ms Allyson Newman1, Dr Tracey Ying1,2, Dr Leyla Aouad1, Prof Kate Wyburn1,2, Prof Steve Chadban1,2
1Royal Prince Alfred Hospital, Camperdown, Australia, 2Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
Biography:
Dr Katie Richards is a current second year Renal Advanced Trainee at Royal Prince Alfred Hospital as part of the NSW Central-Southwest-Regional network. She graduated from the University of New South Wales in 2019 and has trained at both Northern Sydney LHD and Sydney LHD.
Background:
Hepatitis B virus (HBV) nucleic acid testing (NAT) positive donors are frequently declined due to concerns over viral transmission. However, emerging evidence suggests that with appropriate recipient selection and antiviral prophylaxis, these donors can be used safely, potentially expanding the donor pool and reducing transplant wait times.
Case Report:
We report the successful use of a 68-year-old female deceased donor with chronic hepatitis B (HBsAg positive, HBcAb positive, HBsAb negative, HBV NAT positive) for renal transplantation. Her cause of death was due to intracerebral haemorrhage, and she had a terminal acute kidney injury however renal function remained within acceptable parameters (creatinine 96 µmol/L, urine output 100 mL/hr and no proteinuria). Pre-retrieval imaging revealed no signs of cirrhosis or hepatocellular carcinoma.
Two hepatitis B immune recipients with low immunological risk were selected directly from the unit waiting list (out of sequence allocation) and fully consented regarding transmission risk. The left kidney was transplanted into a 74-year-old male with diabetic nephropathy and HBV serology indicating prior exposure and immunity (HBsAg negative, HBcAb positive, HBsAb 345 mIU/mL). He was initiated on entecavir post-transplant. The right kidney was transplanted into a 63-year-old male with chronic HBV (HBsAg positive) already on suppressive entecavir therapy, which was continued post-operatively. Both recipients had undetectable HBV DNA at six weeks post-transplant with no evidence of liver injury. Continued annual monitoring is planned.
Conclusions:
This case supports the safe use of kidneys from HBV NAT positive donors in carefully selected recipients with demonstrated immunity or virologically controlled infection. Antiviral prophylaxis and close monitoring are essential to mitigate transmission risk and support wider use of these donors.