From the Guidelines
When a hepatitis B positive donor lung is transplanted into a hepatitis B negative recipient, the management should focus on preventing hepatitis B virus (HBV) transmission and monitoring for potential infection, with prophylactic antiviral therapy and close monitoring of HBV serologies and DNA levels. The recommended approach includes prophylactic antiviral therapy with entecavir or tenofovir, starting immediately post-transplant and continuing for at least 6-12 months, as suggested by the most recent guidelines 1.
- The choice of antiviral agent should be based on the recipient's risk factors, such as renal dysfunction or bone diseases, and the potential for resistance.
- Regular monitoring should include liver function tests, HBV DNA PCR testing, and HBV serologies (HBsAg, HBsAb, HBcAb) to detect viral replication and potential reactivation.
- Hepatitis B immunoglobulin (HBIG) may be considered in certain cases, such as high-risk donors or recipients with poor adherence to antiviral therapy.
- Vaccination is not necessary for recipients who already have protective antibodies, but may be considered for those who are seronegative. The use of organs from HBV-positive donors can be safe and effective with proper management, as outlined in recent guidelines 1.
- The risk of HBV transmission from HBV-positive donors can be significantly reduced with prophylactic antiviral therapy and close monitoring.
- The choice of antiviral agent and duration of therapy should be individualized based on the recipient's risk factors and response to treatment. Overall, the management of HBV-positive donor lungs transplanted into HBV-negative recipients requires a comprehensive approach that includes prophylactic antiviral therapy, close monitoring, and individualized care to prevent HBV transmission and ensure optimal outcomes 1.
From the Research
Hepatitis B Positive Donor Lungs Transplanted in Hepatitis B Negative Patient
- The use of hepatitis B core antibody (HBcAb) positive donors represents one strategy to increase available donor organs for lung transplantation, with studies suggesting that this approach is safe and effective in vaccinated recipients 2.
- The recipient's hepatitis B status plays a key role in defining the prophylactic strategy, with the availability of safe and effective therapies (hepatitis B antivirals and hepatitis B immune globulin) contributing to the safety of using hepatitis B-positive donors 3.
- Factors that influence the risk of transmission include hepatitis B viral load, vaccination, and antiviral therapy, with vaccinated recipients having a lower risk of seroconversion 4.
Plan of Management
- Vaccinated recipients with a protective hepatitis B surface antibody of at least 10 mIU/mL have a lower risk of seroconversion, and surveillance serologies should be performed to monitor for hepatitis B virus (HBV) recurrence 4.
- Antiviral therapy using newer nucleos(t)ide analogues, such as entecavir or tenofovir, can suppress HBV replication and prevent HBV recurrence in liver transplant recipients, and may also be effective in lung transplant recipients 5, 6.
- The use of hepatitis B immune globulin (HBIG) may be necessary in some cases, particularly in patients with high pretransplant HBV DNA levels or those with limited antiviral options, but can be safely discontinued in some patients and replaced by antiviral monotherapy 5, 6.
Key Considerations
- The risk of viral transmission with hepatitis B-positive donor lungs is considered low in vaccinated recipients, but may be higher in non-vaccinated recipients or those with underlying liver disease 2, 4.
- Regular monitoring for HBV recurrence, including liver function tests and HBV DNA levels, is necessary to ensure early detection and treatment of any potential recurrence 4, 6.
- A multidisciplinary approach to management, including transplantation specialists, hepatologists, and infectious disease specialists, is necessary to ensure optimal care for recipients of hepatitis B-positive donor lungs 3.