Hepatitis A Prevention in Living Kidney Donors
All potential living kidney donors should be screened for hepatitis A virus (HAV) and receive HAV vaccination if not immune, as HAV infection can cause serious complications in transplant recipients. 1, 2, 3
Screening and Evaluation Process
- All potential living kidney donors should undergo comprehensive viral hepatitis screening, including testing for hepatitis A antibodies to determine immunity status 1
- Screening should be performed early in the donor evaluation process to allow time for vaccination if needed 3
- Donors who are not immune to HAV (negative for anti-HAV antibodies) should complete HAV vaccination before donation 1
Vaccination Recommendations
- Living kidney donors should receive a full course of hepatitis A vaccine (2 doses, 6 months apart) before donation 1
- Complete vaccination at least 4 weeks before the planned donation to ensure adequate immune response 1
- HAV vaccination is well-tolerated in transplant candidates and has good immunogenicity when administered before immunosuppression 1
Special Considerations
- If a potential donor has acute HAV infection, donation should be postponed until complete resolution and clearance of the virus 3
- HAV RNA may be detectable in stool for extended periods (up to 126 days reported in some cases), so adequate time should be allowed after infection before proceeding with donation 3
- Donors with recent travel to HAV-endemic areas should be carefully screened before donation 4
Rationale for HAV Prevention
- HAV transmission from donor to recipient has been documented and can cause significant morbidity in transplant recipients 2
- Transplant recipients may experience more severe hepatitis A disease due to immunosuppression 3
- HAV infection in patients with pre-existing liver disease (including HCV infection) can lead to fulminant hepatitis and increased mortality 1, 3
- Transplant recipients may have delayed or impaired antibody responses to HAV infection, complicating diagnosis and management 2
Prevention in Recipients
- Kidney transplant candidates should also be screened for HAV immunity and vaccinated if not immune 1
- Transplant recipients have lower seroconversion rates after vaccination (72% in renal transplant recipients vs. 100% in healthy controls), highlighting the importance of vaccinating before transplantation 1
- The number of immunosuppressive medications inversely correlates with vaccine response, emphasizing the need for vaccination before immunosuppression 1
By implementing comprehensive HAV screening and vaccination protocols for living kidney donors, transplant centers can reduce the risk of donor-derived HAV transmission and improve outcomes for kidney transplant recipients.