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Influence of HBcAb positivity in the organ donor in heart transplantation
1Oficina Regional de Trasplantes de Comunidad de Madrid, Madrid, Spain. carlos.chamorroj@salud.madrid.org
Insights
Hepatitis B core antibody (HBcAb) positive donors impact heart transplant decisions, with varied team protocols. While rare, occult hepatitis B virus (HBV) infection risk exists, manageable through vaccination or prophylaxis.
Area of Science:
- Transplantation immunology
- Infectious disease epidemiology
- Organ donor screening
Background:
- Hepatitis B virus (HBV) transmission risk from HBsAg-negative, HBcAb-positive donors is known in liver transplantation.
- Limited data exists on HBV transmission from HBcAb-positive heart donors.
Purpose of the Study:
- To investigate the influence of HBcAb positivity on heart donor acceptance criteria.
- To update existing literature on HBV transmission in heart transplantation.
Main Methods:
- Survey of Spanish heart transplantation teams regarding donor HBcAb status protocols.
- Medical database review from 1994 to October 2011.
Main Results:
- Protocols for HBcAb-positive donors vary significantly among transplant teams.
- Some teams reject HBcAb-positive donors, others accept them conditionally (e.g., if HBsAb-positive), or use prophylaxis.
- Only one case of hepatitis B reported in a receptor without prophylactic measures.
Conclusions:
- HBcAb seropositivity affects heart donor acceptance, but consensus is lacking.
- Occult HBV infection is possible in HBcAb-positive donors, posing a rare risk.
- Risk mitigation strategies include ensuring adequate HBsAb titers post-vaccination or employing pharmacological prophylaxis.
Objective:
There is a significant risk of hepatitis B transmission from HBsAg (-), HBcAb (+) donors in liver transplantation, but there is little information about hepatitis B transmission from HBcAb heart donors. The present study examines the influence of HBcAb presence in relation to heart donor acceptance and offers an update of the published studies.
Design:
Survey and medical database update from 1994 to October 2011.
Setting:
Spanish heart transplantation teams.
Patients:
Not applicable.
Study Variables:
Acceptance of heart transplant from an HBcAb (+) organ donor.
Results:
Twelve out of 15 surveyed teams were seen to vaccinate against HBV, and two quantify HBsAb titers. Seven teams specifically request donor HBcAb status. If the latter proves positive, two do not accept transplantation, two accept if the donor is also HBsAb (+), one selects the receptor under emergency conditions, and three use drug prophylaxis isolatedly or complementary to the above. Only one case of hepatitis B has been reported in a HBcAb (-) and HBsAb (-) receptor that did not receive prophylactic measures. There have been reports of seroconversion of the HBcAb and HBsAb markers, though with an uncertain etiology.
Conclusions:
HBcAb seropositivity influences acceptance of a heart donor, but agreement is lacking. There is limited information on receptor evolution. To date there has been one reported case of hepatitis B after heart transplant. Although rare, an HBcAb (+) donor can harbor occult HBV infection. The risk of infection can be prevented with appropriate HBsAb titers following vaccination or by pharmacological measures.
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