Renal Outcomes in HBsAg-Positive Living Kidney Donors: A Retrospective Cohort Study

The utilization of hepatitis B surface antigen-positive (HBsAg+) living kidney donors is a strategy to expand the donor pool. However, concerns regarding their renal safety after nephrectomy persist due to the potential impact of chronic HBV infection on the solitary kidney.

In this retrospective cohort study, we analyzed 415 living kidney donors, including 31 (7.5%) who were HBsAg+. Donors were followed for a mean duration of 46.81 months (HBsAg+ group) and 42.10 months (HBsAg- group). The primary outcome was the change in renal function, assessed by serum creatinine levels and the incidence of an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73m². Multivariable linear regression was used to identify factors associated with post-donation renal function change.

Baseline characteristics were comparable. At the last follow-up, there was no significant difference in serum creatinine between HBsAg+ and HBsAg- donors (81.65 µmol/L vs. 81.64 µmol/L, p = .996). The increase in creatinine from baseline was slightly greater in the HBsAg+ group (12.53 µmol/L vs. 11.08 µmol/L), but this difference was not statistically significant (p = .060). The incidence of low eGFR (<45 mL/min/1.73m²) was low in both groups (3.2% vs. 0.5%, p = .543), with no cases of end-stage kidney disease. Multivariable analysis confirmed that HBsAg+ status was not an independent predictor of serum creatinine increase (Estimate 1.42, 95% CI: -0.16 to 3.01; p = .078), whereas hypertension (Estimate 1.89, p = .039) and diabetes (Estimate 3.28, p = .016) were significant predictors.

Over an intermediate-term follow-up, carefully selected HBsAg+ living kidney donors did not exhibit a significantly higher risk of renal impairment compared to HBsAg- donors. HBsAg positivity itself was not an independent risk factor for renal function decline.