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Risk of inappropriate exclusion of organ donors by introduction of hepatitis B core antibody testing
D P Turner1, M Zuckerman, G J Alexander
1Department of Medicine, School of Clinical Medicine, University of Cambridge, UK.
Insights
Hepatitis B core antibody (anti-HBc) testing in UK organ donors showed low prevalence of true positives. Organs from anti-HBc-positive donors did not lead to post-transplant hepatitis B infection, suggesting current exclusion criteria may be too strict.
Area of Science:
- Hepatology
- Transplant Immunology
- Virology
Background:
- Hepatitis B virus (HBV) infection can transmit from organ donors positive for hepatitis B core antibody (anti-HBc) but negative for hepatitis B surface antigen.
- Current practice often excludes anti-HBc-positive donors, potentially limiting organ availability.
Purpose of the Study:
- To determine the prevalence of anti-HBc in UK organ donors.
- To assess the risk of post-transplantation HBV infection in recipients receiving organs from anti-HBc-positive donors.
Main Methods:
- Tested 400 hepatitis B surface antigen-negative organ donor serum samples for anti-HBc.
- Followed recipients of organs from confirmed anti-HBc-positive donors for serological evidence of HBV infection.
Main Results:
- Only 1.25% (5/20) of initially detected anti-HBc-positive results were confirmed upon further testing, indicating poor immunoassay specificity.
- No recipients of organs from confirmed anti-HBc-positive donors developed de novo hepatitis B infection.
Conclusions:
- The specificity of some anti-HBc immunoassays is questionable.
- Excluding organ donors based solely on a single anti-HBc-positive result may lead to unnecessary loss of viable organs.
Background:
Hepatitis B virus infection originating from hepatitis B surface antigen-negative, hepatitis B core antibody (anti-HBc)-positive organ donors has been documented, and anti-HBc-positive donors have been excluded as liver donors. We assessed the prevalence of anti-HBc in UK organ donors and followed up recipients of organs from anti-HBc-positive donors for serological evidence of posttransplantation hepatitis B virus infection.
Methods:
Serum samples from 400 hepatitis B surface antigen-negative organ donors were tested for anti-HBc.
Results:
Only five (1.25%) of 20 sera in which anti-HBc was initially detected were confirmed as anti-HBc positive on further testing. Posttransplantation serum samples from four recipients of confirmed anti-HBc-positive organs showed no evidence of de novo hepatitis B infection.
Conclusions:
The poor specificity of some anti-HBc immunoassays was confirmed and suggests that donor exclusion on the basis of a single anti-HBc-positive result may result in the inappropriate loss of organs.