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World J Hepatol. Aug 27, 2021; 13(8): 853-867
Published online Aug 27, 2021. doi: 10.4254/wjh.v13.i8.853
Kidney transplant from donors with hepatitis B: A challenging treatment option
Praopilad Srisuwarn, Vasant Sumethkul
Praopilad Srisuwarn, Vasant Sumethkul, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Srisuwarn P and Sumethkul V outlined the scope; Srisuwarn P collected the information; Srisuwarn P and Sumethkul V wrote, read and final approval the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vasant Sumethkul, FACP, FRCP (Hon), MD, Full Professor, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok 10400, Thailand. vasant.sum@mahidol.ac.th
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: June 4, 2021
Revised: June 22, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: August 27, 2021
Abstract

Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation. However, the risk of hepatitis B virus (HBV) transmission remains a challenge that undermines the chance of organs being used. This is particularly true with hepatitis B surface antigen (HBsAg) positive donors despite the comparable long-term outcomes when compared with standard donors. To reduce the risk of HBV transmission, a comprehensive approach is needed. This includes assessment of donor risk, optimal allocation to the proper recipient, appropriate immunosuppressive regimen, optimizing the prophylactic therapy, and post-transplant monitoring. This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment. The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening, optimal recipient selection, importance of hepatitis B immunity, role of nucleos(t)ide analogues, and hepatitis B immunoglobulin. A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.

Keywords: Hepatitis B virus, Organ donor, Recipient allocation, Kidney transplant, Transmission, Long term outcomes

Core Tip: Low-risk hepatitis B surface antigen (HBsAg) positive kidney donor, defined by a negative test of hepatitis B virus (HBV) DNA being allocated to immune-recipients with anti-HBs at least 10 mIU/mL is a key factor in overcoming the risk of HBV transmission. The risk may be further eliminated with optimal nucleos(t)ide analog prophylaxis. Blood tests for HBV DNA, HBs Ag, and liver function tests should be routinely monitored after transplantation and when there is a change of immunosuppression. The excellent long-term outcomes being reported suggested that the outcomes of this treatment option are promising. This will lead to broader use of organs with positive HBsAg.