Viremic Hepatitis B Donors: A Case of Why It's Time to Further Expand the Donor Pool for Thoracic Transplant

INTRODUCTION: In light of a national shortage of thoracic organs, patients with end stage lung disease need an expanded donor pool. There are approximately 847,000 persons with chronic hepatitis B virus (HBV) in the U.S. Previously, transplantation of HBV viremic donors into negative recipients was considered an absolute contraindication. We present a case of an HBV viremic lung donor transplanted into an HBV negative recipient without significant complication. CASE REPORT: A 66-year-old man with rapidly progressive idiopathic pulmonary fibrosis, diagnosed 1.5 years prior, was listed for lung transplant. Given his dramatic deterioration [Table 1], a broader donor pool was sought, and he was consented for hepatitis C and/or HBV viremic donors under IRB protocol. He was listed for less than 24 hours prior to organ offer. He underwent bilateral lung transplant from a donor with a positive HBsAg and HBV viral load of 726,220 IU/mL. The recipient was immunized as a child as reflected by his positive HBsAb 163mIU/mL. He was given 9360 units HBIG on d0 after transplant, 4680 units daily d1-d5 and started on entecavir 0.5mg/d d1. Since transplant, he has had normal liver function tests, and has not seroconverted his HBcAb, nor developed a positive sAg or NAT. We queried the OPTN database for all HBV mismatched solid organ transplant episodes from July 2017 through June 2019, as measured by +sAg and/or NAT. There were 214 living and deceased donor transplants utilizing HBV-positive donor organs into negative recipients, only 4 of which were lung transplants [Table 2]. There were 27 HBV mismatch recipients with 6 month follow up data on the OPTN database. By 6 months post-transplant, 2 recipients had seroconverted, only 1 of whom became viremic. SUMMARY: Our case demonstrates HBV-infected thoracic donors can be safely transplanted to HBV negative recipients. Although optimal dosing and duration of HBIG and entecavir is not known, this may be a viable pathway to transplant for patients who need an expanded donor pool.

Duke Scholars

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