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Yamaya T, Sato M, Konoeda C, Nakajima J. Living-donor lobar lung transplantation from a hepatitis B surface antigen-positive donor to a negative recipient. BMJ Case Rep 2023; 16:e255663. [PMID: 37816581 PMCID: PMC10565166 DOI: 10.1136/bcr-2023-255663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
A man in his 40s was diagnosed with interstitial pneumonia at another hospital. He was referred to our hospital for lung transplantation. His lung function was rapidly declining, necessitating semiurgent living-donor lobar lung transplantation (LDLLT). Although he was negative for hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb), one of the candidate donors was proven HBsAg-positive. The risk of hepatitis B virus (HBV) infection at transplantation was considered high; however, after careful discussion about the safety of the recipient and donor, it was decided to conduct LDLLT. For prophylaxis, human anti-HBV surface immunoglobulin and entecavir were administered to the recipient. HBsAg and HBsAb were continuously monitored postoperatively and consistently negative, suggesting no signs of reactivation in the recipient, even after corticosteroid pulse treatment for acute cellular rejection. More than 6 months after LDLLT, there were no signs of HBV reactivation in either the recipient or donor.
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Affiliation(s)
- Takafumi Yamaya
- Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Chihiro Konoeda
- Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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2
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Zhang N, Wang D, Hu X, Zhang G, Li Z, Zhao Y, Liu Z, Wang Y. Analysis of immune status in gastric adenocarcinoma with different infiltrating patterns and origin sites. Front Immunol 2022; 13:978715. [PMID: 36081505 PMCID: PMC9445833 DOI: 10.3389/fimmu.2022.978715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Tumor infiltration pattern (INF) and tumor origin site were reported to significantly affect the prognosis of gastric cancer (GC), while the immune status under these contexts is not clear. In this study, we correlated the density and phenotype of tumor-infiltrating lymphocytes (TILs) with INF and the tumor origin site to reflect the biological behavior of tumors from a new perspective and also determined their effects on overall survival (OS) and other related clinicopathological features in archival samples of 147 gastric cancers with 10-year follow-up data. We found that the INFc growth pattern (an invasive growth without a distinct border) of GC lacked immune cell infiltration, particularly the cytotoxic T cells and their activated form. It is also significantly associated with an unfavorable prognosis (P < 0.001) and proximal site (P = 0.001), positive lymph node metastasis (P = 0.002), and later tumor–node–metastasis stage (P < 0.001). Moreover, the density and sub-type of TILs infiltration were significantly different in disparate differentiated areas for the tumor tissue with INFb. Compared with distal gastric cancer, proximal gastric cancers were prone to grow in an INFc pattern (P = 0.001) and infiltrated with fewer TILs, experiencing a shorter survival time (P = 0.013). Multivariate analysis showed that only the INF and the density of TILs were demonstrated to be the independent prognostic factors of OS for the GC. We concluded that GC with an aggressive growth pattern arising from proximal sites always had a weak immune response and resulted in a poor prognosis. The interaction between them and their synergistic or antagonistic effects in the development of tumors need to be further studied. This study opens up a new perspective for research on the biological behavior of the tumor.
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Affiliation(s)
- Nana Zhang
- Institute of Regenerative and Reconstructive Medicine, Med-X Institute, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Institute for Cancer Research, School of Basic Medical Science, Health Science Center of Xi’an Jiaotong University, Xian, China
| | - Depu Wang
- Institute for Cancer Research, School of Basic Medical Science, Health Science Center of Xi’an Jiaotong University, Xian, China
- Department of Science and Technology, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, China
| | - Xiaoyan Hu
- Institute for Cancer Research, School of Basic Medical Science, Health Science Center of Xi’an Jiaotong University, Xian, China
| | - Guanjun Zhang
- Institute for Cancer Research, School of Basic Medical Science, Health Science Center of Xi’an Jiaotong University, Xian, China
- Department of Pathology, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, China
| | - Zhuoqun Li
- Institute of Regenerative and Reconstructive Medicine, Med-X Institute, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yan Zhao
- Institute of Regenerative and Reconstructive Medicine, Med-X Institute, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhijun Liu
- Institute of Regenerative and Reconstructive Medicine, Med-X Institute, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Zhijun Liu, ; Yili Wang,
| | - Yili Wang
- Institute of Regenerative and Reconstructive Medicine, Med-X Institute, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Institute for Cancer Research, School of Basic Medical Science, Health Science Center of Xi’an Jiaotong University, Xian, China
- *Correspondence: Zhijun Liu, ; Yili Wang,
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3
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Bacterial and Viral Infections in Liver Transplantation: New Insights from Clinical and Surgical Perspectives. Biomedicines 2022; 10:biomedicines10071561. [PMID: 35884867 PMCID: PMC9313066 DOI: 10.3390/biomedicines10071561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 01/03/2023] Open
Abstract
End-stage liver disease patients undergoing liver transplantation are prone to develop numerous infectious complications because of immunosuppression, surgical interventions, and malnutrition. Infections in transplant recipients account for the main cause of mortality and morbidity with rates of up to 80%. The challenges faced in the early post-transplant period tend to be linked to transplant procedures and nosocomial infections commonly in bloodstream, surgical, and intra-abdominal sites. Viral infections represent an additional complication of immunosuppression; they can be donor-derived, reactivated from a latent virus, nosocomial or community-acquired. Bacterial and viral infections in solid organ transplantation are managed by prophylaxis, multi-drug resistant screening, risk assessment, vaccination, infection control and antimicrobial stewardship. The aim of this review was to discuss the epidemiology of bacterial and viral infections in liver transplants, infection control issues, as well as surgical frontiers of ex situ liver perfusion.
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Malinis M, Boucher HW. Screening of donor and candidate prior to solid organ transplantation—Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13548. [DOI: 10.1111/ctr.13548] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Maricar Malinis
- Section of Infectious Diseases Yale School of Medicine New Haven Connecticut
| | - Helen W. Boucher
- Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Boston Massachusetts
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5
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Lui SL, Yap D, Cheng V, Chan TM, Yuen KY. Clinical practice guidelines for the provision of renal service in Hong Kong: Infection Control in Renal Service. Nephrology (Carlton) 2019; 24 Suppl 1:98-129. [PMID: 30900339 PMCID: PMC7167703 DOI: 10.1111/nep.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
| | - Desmond Yap
- Department of MedicineThe University of Hong KongHong Kong
| | - Vincent Cheng
- Department of MicrobiologyQueen Mary HospitalHong Kong
| | - Tak Mao Chan
- Department of MedicineThe University of Hong KongHong Kong
| | - Kwok Yung Yuen
- Department of MicrobiologyThe University of Hong KongHong Kong
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6
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Parameswaran S, Puthiyottil D, Ramesh AS, Dhodapkar R, Ramanitharan M, Mishra S, Pathak N, Choudhury S, Vazhayil A, Lalgudi D, Kodakkattil S, Priyamvada P. Successful kidney transplantation from a deceased donor with chronic hepatitis B infection and review of literature. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_12_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Avery RK, Yen-Lieberman B. Viral Diagnostics. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7115029 DOI: 10.1007/978-1-4939-9034-4_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This chapter discusses recent developments in diagnostics for cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), community respiratory viruses (CRVs), parvovirus, hepatitis viruses, HIV, and other viral agents of importance in solid organ and hematopoietic stem cell transplantation.
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8
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Chien RN, Kao JH, Peng CY, Chen CH, Liu CJ, Huang YH, Hu TH, Yang HI, Lu SN, Ni YH, Chuang WL, Lee CM, Wu JC, Chen PJ, Liaw YF. Taiwan consensus statement on the management of chronic hepatitis B. J Formos Med Assoc 2018; 118:7-38. [PMID: 30527436 DOI: 10.1016/j.jfma.2018.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 01/10/2023] Open
Abstract
The experts of Taiwan Association for the Study of Liver (TASL) have actively participated and led the guidelines on hepatitis B virus (HBV) management by Asian Pacific Association for the Study of Liver (APASL) which is the first international association for the study of liver to publish the statement on HBV management before. However, there are more and more new data on the natural history and treatment of HBV infection in the past decade. These include new application of an old biomarker (quantitative HBsAg), clinical significance of HBV genotype and naturally occurring mutations, the role of non-invasive examination in evaluating severity of hepatic fibrosis, clinical significance of outcome calculators, new drug or new combination strategies towards more effective therapy and organ transplantation including liver and non-liver transplantation. It is time to publish the guidelines on HBV management of Taiwan. Hence, TASL have conducted an expert meeting to review, to discuss and to debate the relevant literatures, followed by draft the manuscript of HBV management guidelines and recommendations. The guidelines include general management, indications for fibrosis assessment, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug resistance, concurrent viral infection, hepatic decompensation, patient receiving immune suppression or chemotherapy and patients in the setting of liver transplantation and hepatocellular carcinoma, are also included.
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Affiliation(s)
- Rong-Nan Chien
- Liver Research Unit, Linkou Chang Gung Memorial Hospital and University College of Medicine, Taoyuan, Taiwan.
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Cheng-Yuan Peng
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Hung Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine, Department of Internal Medicine and Hepatitis Research Center, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tsung-Hui Hu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hwa-I Yang
- Department of Genomic Research Center, Sinica Academia, Taipei, Taiwan
| | - Sheng-Nan Lu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan
| | - Won-Long Chuang
- Division of Hepatobiliary and Pancreas, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chuan-Mo Lee
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jaw-Chin Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Pei-Jer Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yun-Fan Liaw
- Liver Research Unit, Linkou Chang Gung Memorial Hospital and University College of Medicine, Taoyuan, Taiwan
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Fabrizi F, Bunnapradist S, Lunghi G, Villa M, Martin P. Transplanting Solid Organs from HBsAg Negative Donors Positive for Antibody to Hepatitis B Core Antigen: The Implications. Int J Artif Organs 2018; 26:972-83. [PMID: 14708825 DOI: 10.1177/039139880302601102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- F Fabrizi
- Division of Nephrology, Dialysis and Transplantation, Institute of Hygiene and Preventive Medicine, Policlinico IRCCS, Milan, Italy.
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10
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Lee JH, Kim HS, Lee DY, Oh JS, Sin YH, Kim JK, Park JH, Huh K, Park JI. A Successful Case of a High Anti A/B Antibody Titer ABO Incompatible Kidney Transplantation Patient Who Received a Kidney from a Hepatitis B Carrier. KOREAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.4285/jkstn.2016.30.4.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jin Ho Lee
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Han Sae Kim
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Dong Yeol Lee
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Joon Seok Oh
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Yong Hun Sin
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Joong Kyung Kim
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Jong Hyun Park
- Department of General Surgery, Bong Seng Memorial Hospital, Busan, Korea
| | - Kill Huh
- Department of General Surgery, Bong Seng Memorial Hospital, Busan, Korea
| | - Jong In Park
- Department of Laboratory Medicine, Bong Seng Memorial Hospital, Busan, Korea
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11
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Salter T, Burton H, Douthwaite S, Newsholme W, Horsfield C, Hilton R. Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient. Case Rep Transplant 2016; 2016:3152495. [PMID: 27800206 PMCID: PMC5075308 DOI: 10.1155/2016/3152495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 09/08/2016] [Indexed: 01/04/2023] Open
Abstract
Hepatitis B virus (HBV) presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy (RRT) and HBV surveillance in kidney transplant recipients. We report the case of a 56-year-old male who was immunised against HBV before starting haemodialysis. He received a deceased donor kidney transplant three years later, at which time there was no evidence of HBV infection. After a further six years he developed an acute kidney injury; allograft biopsy revealed an acute thrombotic microangiopathy (TMA) with glomerulitis, peritubular capillaritis, and C4d staining. Due to a "full house" immunoprofile, tests including virological screening were undertaken, which revealed acute HBV infection. Entecavir treatment resulted in an improvement in viral load and kidney function. HBV genotyping demonstrated a vaccine escape mutant, suggesting "past resolved" infection that reactivated with immunosuppression, though posttransplant acquisition cannot be excluded. This is the first reported case of acute HBV infection associated with immune complex mediated glomerulonephritis and TMA. Furthermore, it highlights the importance of HBV surveillance in kidney transplant recipients, which although addressed by UK guidelines is not currently practiced in all UK units.
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Affiliation(s)
- Tracey Salter
- Departments of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hannah Burton
- Departments of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sam Douthwaite
- Department of Virology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - William Newsholme
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Catherine Horsfield
- Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel Hilton
- Departments of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Veroux M, Ardita V, Corona D, Giaquinta A, Ekser B, Sinagra N, Zerbo D, Patanè M, Gozzo C, Veroux P. Kidney Transplantation From Donors with Hepatitis B. Med Sci Monit 2016; 22:1427-34. [PMID: 27123988 PMCID: PMC4915324 DOI: 10.12659/msm.896048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The growing demand for organ donors to supply the increasing number of patients on kidney waiting lists has led most transplant centers to develop protocols that allow safe use of organs from donors with special clinical situations previously regarded as contraindications. Deceased donors with previous hepatitis B may be a safe resource to increase the donor pool even if there is still controversy among transplantation centers regarding the use of hepatitis B surface antigen-positive donors for renal transplantation. However, when allocated to serology-matched recipients, kidney transplantation from donors with hepatitis B may result in excellent short-term outcome. Many concerns may arise in the long-term outcome, and studies must address the evaluation of the progression of liver disease and the rate of reactivation of liver disease in the recipients. Accurate selection and matching of both donor and recipient and correct post-transplant management are needed to achieve satisfactory long-term outcomes.
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Affiliation(s)
- Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Vincenzo Ardita
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Daniela Corona
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Burcin Ekser
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Nunziata Sinagra
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, university Hospital of Catania, Catania, Italy
| | - Domenico Zerbo
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, university Hospital of Catania, Catania, Italy
| | - Marco Patanè
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Cecilia Gozzo
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
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Jun H, Kim MG, Park KT, Jung CW. Living-donor kidney transplant from hepatitis B surface antigen-positive donors to hepatitis B antibody-positive recipients without hepatitis B immunoglobulin prophylaxis in an endemic country. EXP CLIN TRANSPLANT 2016; 13 Suppl 1:256-8. [PMID: 25894166 DOI: 10.6002/ect.mesot2014.p60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Living-donor kidney transplant from donors who are chronically infected with hepatitis B virus can be considered as a possibility to compensate for insufficiency of organ transplants, particularly in a hepatitis B virus endemic country. In this study, the safety and efficacy were reviewed retrospectively in living-donor kidney transplant from donors who were chronically infected with hepatitis B virus. MATERIALS AND METHODS In the years between 2012 and 2013, we transplanted 4 renal grafts from hepatitis B surface antigen-positive living donors to antihepatitis B antibody-positive recipients. Lamivudine was prescribed for recipients after transplant without hepatitis B immunoglobulin. RESULTS In 1-year follow-up, there were no abnormal findings in the levels of renal and liver enzymes, and there was no unwanted seroconversion to positive hepatitis B surface antigen. CONCLUSIONS When combined with careful hepatitis B virus-monitoring, renal grafts from hepatitis B surface antigen-positive living donors can be transplanted to hepatitis B antibody-positive recipients, without the need for hepatitis B immunoglobulin prophylaxis, in a hepatitis B virus endemic country.
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Affiliation(s)
- Heungman Jun
- From the Department of Surgery, Korea University Anam Hospital, Seoul, Korea
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14
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Donor-Derived Infections: Incidence, Prevention, and Management. TRANSPLANT INFECTIONS 2016. [PMCID: PMC7123109 DOI: 10.1007/978-3-319-28797-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Organ donors reflect the diverse US population, and there are an increasing number of donors born in, who have resided in, or who have traveled to underdeveloped areas of the world or areas with geographically restricted infections. As such, these donors are exposed to pathogens that can potentially be transmitted to recipients of the donor’s organs. Additionally, there are newer techniques to identify many pathogens that may be transmitted from the donor to the transplant recipients. Finally, high-profile reports of several donor-derived infections have heightened awareness of donor-derived infections and have likely contributed to increased recognition. In this chapter, the incidence, methods of identification and prevention, and management of unexpected donor-derived infections will be reviewed.
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15
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Huprikar S, Danziger-Isakov L, Ahn J, Naugler S, Blumberg E, Avery RK, Koval C, Lease ED, Pillai A, Doucette KE, Levitsky J, Morris MI, Lu K, McDermott JK, Mone T, Orlowski JP, Dadhania DM, Abbott K, Horslen S, Laskin BL, Mougdil A, Venkat VL, Korenblat K, Kumar V, Grossi P, Bloom RD, Brown K, Kotton CN, Kumar D. Solid organ transplantation from hepatitis B virus-positive donors: consensus guidelines for recipient management. Am J Transplant 2015; 15:1162-72. [PMID: 25707744 DOI: 10.1111/ajt.13187] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/08/2014] [Accepted: 12/24/2014] [Indexed: 01/25/2023]
Abstract
Use of organs from donors testing positive for hepatitis B virus (HBV) may safely expand the donor pool. The American Society of Transplantation convened a multidisciplinary expert panel that reviewed the existing literature and developed consensus recommendations for recipient management following the use of organs from HBV positive donors. Transmission risk is highest with liver donors and significantly lower with non-liver (kidney and thoracic) donors. Antiviral prophylaxis significantly reduces the rate of transmission to liver recipients from isolated HBV core antibody positive (anti-HBc+) donors. Organs from anti-HBc+ donors should be considered for all adult transplant candidates after an individualized assessment of the risks and benefits and appropriate patient consent. Indefinite antiviral prophylaxis is recommended in liver recipients with no immunity or vaccine immunity but not in liver recipients with natural immunity. Antiviral prophylaxis may be considered for up to 1 year in susceptible non-liver recipients but is not recommended in immune non-liver recipients. Although no longer the treatment of choice in patients with chronic HBV, lamivudine remains the most cost-effective choice for prophylaxis in this setting. Hepatitis B immunoglobulin is not recommended.
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Affiliation(s)
- S Huprikar
- Icahn School of Medicine at Mount Sinai, New York, NY
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16
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Ohno Y, Mita A, Ikegami T, Masuda Y, Urata K, Nakazawa Y, Kobayashi A, Miyagawa S. Successful active immunization using a hepatitis B virus vaccination protocol for a recipient with hepatitis B core antibody-positive liver graft. Transplant Proc 2015; 46:721-5. [PMID: 24767333 DOI: 10.1016/j.transproceed.2013.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/26/2013] [Accepted: 12/10/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Donor shortages occasionally necessitate the use of hepatic allografts from hepatitis B core antibody-positive (HBcAb+) donors, with an attendant risk of post-transplantation hepatitis B virus (HBV) infection. The aim of the present study was to develop and evaluate a protocol of active immunization for prevention of post-transplantation de novo HBV infection in patients receiving liver grafts from HBcAb+ donors. PATIENTS AND METHODS Ten patients who had received HBcAb+ liver grafts at Shinshu University Hospital between October 1996 and December 2012 were enrolled. All the recipients were negative for HBV serological tests, and HBV-DNA. Hepatitis B immunoglobulin (HBIG) was given routinely in the peritransplantation and post-transplantation periods, without antiviral drugs. Subcutaneous vaccination with recombinant HBV was given at a dosage of 20 μg in adults and 5 μg in children concomitant with HBIG until acquisition of active immunization. The timing to start HBV vaccination was dependent on the condition of the patient. RESULTS The median follow-up period after liver transplantation was 140 months, and the median period after transplantation until the start of vaccination was 7.0 months. Nine patients (90%) acquired active immunity after a median number of 4 (range, 2-13) vaccinations (hepatitis B surface antibody >300 mIU/mL for 1 year, or >100 mIU/mL thereafter), and did not require HBIG administration thereafter. None had any side effects of HBV vaccination or developed hepatitis B infection during the study period. Four fast responders who achieved antibody high titers by active immunization within 9 months received pretransplantation vaccinations, whereas 5 slow responders did not. CONCLUSIONS Our vaccination protocol provides a new effective strategy for prevention of de novo hepatitis B infection after liver transplantation in recipients with HBcAb+ liver grafts. Pretransplantation HBV vaccination was helpful for the post-transplantation vaccine response.
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Affiliation(s)
- Y Ohno
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - A Mita
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - T Ikegami
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Masuda
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Urata
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Nakazawa
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - A Kobayashi
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Miyagawa
- Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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17
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Horan JL, Stout JE, Alexander BD. Hepatitis B core antibody-positive donors in cardiac transplantation: a single-center experience. Transpl Infect Dis 2014; 16:859-63. [PMID: 25154437 DOI: 10.1111/tid.12280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 05/03/2014] [Accepted: 06/01/2014] [Indexed: 01/15/2023]
Abstract
Hepatitis B virus (HBV) core antibody (HBcAb)-positive donors are increasingly utilized in solid organ transplantation. We report a single center's experience in cardiac transplantation with 18 HBcAb-positive donors. Available follow-up on recipients of cardiac allografts from HBcAb-positive donors, including 2 donors with low-level serum HBV DNA at the time of transplantation, demonstrated no documented donor-derived HBV transmission.
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Affiliation(s)
- J L Horan
- Department of Medicine/Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
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18
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Jr CSK, Koval CE, Duin DV, Morais AGD, Gonzalez BE, Avery RK, Mawhorter SD, Brizendine KD, Cober ED, Miranda C, Shrestha RK, Teixeira L, Mossad SB. Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections. World J Transplant 2014; 4:43-56. [PMID: 25032095 PMCID: PMC4094952 DOI: 10.5500/wjt.v4.i2.43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/21/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompting increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.
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Hanson K, Alexander B. Strategies for the prevention of infection after solid organ transplantation. Expert Rev Anti Infect Ther 2014; 4:837-52. [PMID: 17140359 DOI: 10.1586/14787210.4.5.837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Infection is a frequent complication of organ transplantation and is associated with significant morbidity and mortality. Preventative antimicrobial strategies are a key component of the care received by transplant patients. This review summarizes the evidence supporting anti-infective prophylaxis in this setting. Specific recommendations for the prevention of bacterial, fungal, viral and parasitic infection after transplant are made, with a focus on recent developments in the field of transplant infectious diseases.
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Affiliation(s)
- Kimberly Hanson
- Duke University Medical Center, Division of Infectious Diseases and International Health, Duke Clinical Microbiology Laboratory, NC 27710, USA.
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21
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Affiliation(s)
- S. A. Fischer
- Transplant Infectious Diseases, Rhode Island Hospital. The Warren Alpert Medical School of Brown UniversityProvidenceRI
| | - K. Lu
- Center of Evidence‐Based Medicine, Division of Urology, Department of SurgeryE‐Da Hospital. I‐Shou UniversityTaiwan
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22
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Levitsky J, Doucette K. Viral hepatitis in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:147-68. [PMID: 23465008 DOI: 10.1111/ajt.12108] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J Levitsky
- Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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23
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Abstract
Over the past decade, the solid organ transplant community has focused increased attention on unexpected transmission of infectious pathogens from organ donor to recipient. While unexpected donor-derived infections are relatively uncommon, recent cases of transmission of human immunodeficiency virus (HIV) and hepatitis C to multiple recipients, as well as transmission of HIV from a living donor, have further increased interest in improving the safety of solid organ transplantation. This article will review the epidemiology and outcomes associated with unexpected donor-derived infection. Furthermore, the reporting and patient safety process will be discussed, as will preventative measures that can reduce the burden of donor-derived infection.
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24
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Len Ó, Ramos A, Pahissa A. Evaluating the risk of transmission of infection from donor to recipient of a solid organ transplantation. Enferm Infecc Microbiol Clin 2012; 30 Suppl 2:19-26. [PMID: 22542031 PMCID: PMC7130295 DOI: 10.1016/s0213-005x(12)70078-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the context of solid organ transplantation, screening of potential organ donors is crucial, and should be performed with great rigor to minimize the risk of transmission of certain infectious processes. This review aims to update understanding of the possible pathologies involved, as well as of emerging infections that, as a result of globalization, are gaining increasing prominence on a daily basis.
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Affiliation(s)
- Óscar Len
- Infectious Diseases Department, Hospital Vall d'Hebron, Barcelona, Spain.
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25
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Veroux M, Corona D, Ekser B, Giaquinta A, Tallarita T, De Martino C, Gentile F, Virgilio C, Gagliano M, Fiamingo P, Veroux P. Kidney Transplantation From Hepatitis B Virus Core Antibody–Positive Donors: Prophylaxis With Hepatitis B Immunoglobulin. Transplant Proc 2011; 43:967-70. [DOI: 10.1016/j.transproceed.2011.01.155] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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26
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Fridell JA, Rogers J, Stratta RJ. The pancreas allograft donor: current status, controversies, and challenges for the future. Clin Transplant 2011; 24:433-49. [PMID: 20384731 DOI: 10.1111/j.1399-0012.2010.01253.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The pancreas allograft is a scarce resource that is currently underutilized. The selection of appropriate deceased donors for pancreas procurement is of paramount importance for minimizing technical failure and optimizing long-term outcomes in pancreas transplantation. Despite the increasing demand for pancreas transplantation, increases in overall organ donation rates and the evolution of criteria that constitute an "acceptable" pancreas donor, the number of deceased donor pancreas transplants being performed in the United States has actually declined in recent years. Although there are many factors that must be considered during evaluation of the potential pancreas allograft donor to minimize morbidity and graft loss, it is evident that there are transplantable organs that are not used. In this review, deceased donor pancreas identification, management, selection, allocation, assessment, preservation, and the problem of pancreas underutilization will be discussed.
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Affiliation(s)
- Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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27
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28
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Ouseph R, Eng M, Ravindra K, Brock GN, Buell JF, Marvin MR. Review of the use of hepatitis B core antibody–positive kidney donors. Transplant Rev (Orlando) 2010; 24:167-71. [DOI: 10.1016/j.trre.2010.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 04/28/2010] [Accepted: 05/17/2010] [Indexed: 01/05/2023]
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29
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Successful outcome of kidney transplantation from a HBV-DNA positive donor into recipients with cleared HBV-infection using a pre-emptive therapy approach. J Clin Virol 2010; 49:53-7. [DOI: 10.1016/j.jcv.2010.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 06/29/2010] [Indexed: 12/22/2022]
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30
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Morris MI, Fischer SA, Ison MG. Infections Transmitted by Transplantation. Infect Dis Clin North Am 2010; 24:497-514. [DOI: 10.1016/j.idc.2010.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Humar A, Morris M, Blumberg E, Freeman R, Preiksaitis J, Kiberd B, Schweitzer E, Ganz S, Caliendo A, Orlowski JP, Wilson B, Kotton C, Michaels M, Kleinman S, Geier S, Murphy B, Green M, Levi M, Knoll G, Segev DL, Brubaker S, Hasz R, Lebovitz DJ, Mulligan D, O'Connor K, Pruett T, Mozes M, Lee I, Delmonico F, Fischer S. Nucleic acid testing (NAT) of organ donors: is the 'best' test the right test? A consensus conference report. Am J Transplant 2010; 10:889-899. [PMID: 20121734 DOI: 10.1111/j.1600-6143.2009.02992.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Nucleic acid testing (NAT) for HIV, HBV and HCV shortens the time between infection and detection by available testing. A group of experts was selected to develop recommendations for the use of NAT in the HIV/HBV/HCV screening of potential organ donors. The rapid turnaround times needed for donor testing and the risk of death while awaiting transplantation make organ donor screening different from screening blood-or tissue donors. In donors with no identified risk factors, there is insufficient evidence to recommend routine NAT, as the benefits of NAT may not outweigh the disadvantages of NAT especially when false-positive results can lead to loss of donor organs. For donors with identified behavioral risk factors, NAT should be considered to reduce the risk of transmission and increase organ utilization. Informed consent balancing the risks of donor-derived infection against the risk of remaining on the waiting list should be obtained at the time of candidate listing and again at the time of organ offer. In conclusion, there is insufficient evidence to recommend universal prospective screening of organ donors for HIV, HCV and HBV using current NAT platforms. Further study of viral screening modalities may reduce disease transmission risk without excessive donor loss.
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Affiliation(s)
- A Humar
- Transplant Infectious Diseases, University of Alberta
| | - M Morris
- Infectious Diseases, University of Miami Miller School of Medicine
| | - E Blumberg
- Infectious Diseases, University of Pennsylvania
| | | | - J Preiksaitis
- Transplant Infectious Diseases, University of Alberta
| | - B Kiberd
- Queen Elizabeth II Health Sciences Centre, Nephrology
| | | | - S Ganz
- University of Miami Miller School of Medicine
| | - A Caliendo
- Emory University School of Medicine, Pathology and Lab Medicine
| | | | - B Wilson
- Association of Organ Procurement Organizations
| | - C Kotton
- Infectious Diseases, Massachusetts General Hospital
| | - M Michaels
- Pediatric Infectious Diseases, Children's Hospital of Pittsburgh
| | | | | | | | - M Green
- University of Pittsburgh School of Medicine
| | - M Levi
- University of Colorado Denver
| | | | | | | | - R Hasz
- Association of Organ Procurement Organizations (AOPO)
| | | | | | - K O'Connor
- Association of Organ Procurement Organizations (AOPO)
| | - T Pruett
- University of Virginia Health System
| | - M Mozes
- Gift of Hope Organ and Tissue Donor Network
| | - I Lee
- Infectious Diseases, University of Pennsylvania
| | | | - S Fischer
- The Warren Alpert Medical School of Brown University and Rhode Island Hospital Joint consensus recommendations endorsed by: American Society of Transplantation (AST), Canadian Society of Transplantation (CST), American Society of Transplant Surgeons (ASTS). With additional sponsorship by: United Network for Organ Sharing (UNOS), American Association of Tissue Banks (AATB), Association of Organ Procurement Organizations (AOPO)
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32
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Affiliation(s)
- J Levitsky
- Division of Hepatology and Organ Transplantation, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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33
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Affiliation(s)
- S. A. Fischer
- Department of Medicine and Transplant Services, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - R. K. Avery
- Department of Infectious Disease, The Cleveland Clinic, Cleveland, OH
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34
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Jiang H, Wu J, Zhang X, Wu D, Huang H, He Q, Wang R, Wang Y, Zhang J, Chen J. Kidney transplantation from hepatitis B surface antigen positive donors into hepatitis B surface antibody positive recipients: a prospective nonrandomized controlled study from a single center. Am J Transplant 2009; 9:1853-8. [PMID: 19538486 DOI: 10.1111/j.1600-6143.2009.02707.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The number of patients on renal transplant waiting list is increasing rapidly in many countries, exacerbating the shortage of organs. We conducted a study to evaluate the safety and efficacy of deceased-donor kidney transplantation from hepatitis B surface antigen (HBsAg)-positive (+) donors into hepatitis B surface antibody (anti-HBs)-positive (+) recipients. Sixty-five patients received grafts from HBsAg(+) donors, and 308 subjects received grafts from HBsAg-negative(-) donors. Posttransplantation, recipients with HBsAg(-) grafts or HBsAg(+) grafts received 400 U of hepatitis B immunoglobulin once and twice, respectively. The seven recipients who received grafts from hepatitis B virus (HBV) DNA(+) donors were treated with hepatitis B immunoglobulin 400 U weekly for 3 months and lamivudine 100 mg daily for 6 months. All patients were monitored for liver function and hepatitis B viral status. The follow-up period was 38.7 +/- 15.4 months. Although two recipients developed de novo HBV infection, neither patient developed severe liver dysfunction nor died. The incidence of liver injury (39/65 vs. 207/308, chi-square test, p > 0.05) and survival (log-rank test, p > 0.05) did not differ between the groups. We conclude that anti-HBs(+) recipients receiving HBsAg(+) grafts did as well as those receiving HBsAg(-) grafts.
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Affiliation(s)
- H Jiang
- The Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
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35
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Abstract
Donor-derived infectious diseases are infections that are present in an organ donor and have the potential to be transmitted to at least 1 transplant recipient. Several recent transmissions have been covered by the lay media and in the medical literature, including a recent transmission of HIV and hepatitis C virus from 1 donor to 4 recipients. These reports have highlighted the importance and clinical impact of this rare complication of organ transplantation. Donor-derived infectious diseases appear to complicate less than 1% of all transplant procedures, but, when a transmission occurs, significant morbidity and mortality can occur. A number of guidelines and policies define the optimal screening of organ donors to prevent the transmission of infectious diseases. Unfortunately, there are significant limitations in our screening methods, and only some pathogens are screened for routinely. The regulatory framework related to and the epidemiology, identification, and management of donor-derived infectious disease transmission shall be reviewed.
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36
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Lee VTW, Yip CC, Ganpathi IS, Chang S, Mak KSW, Prabhakaran K, Madhavan K. Expanding the Donor Pool for Liver Transplantation in the Setting of an “Opt-out” Scheme – 3 years after New Legislation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n4p315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The revised Human Organ Transplant Act (HOTA) was implemented in Singapore in July 2004. We aim to evaluate expanding the potential donor pool for liver transplant in Singapore with the inclusion of marginal donors.
Materials and Methods: All donor referrals between July 2004 and June 2007 were studied. All potential deceased liver donors were heart-beating. After being reviewed by the transplant coordinator, potential donors were assessed by a transplant hepatologist and a transplant surgeon for suitability of organ donation strictly based on the programme’s donor assessment protocol. Reasons for rejection as potential donors were documented. The clinical characteristics of all donor referrals were retrospectively reviewed, and an independent decision was made as to whether liver retrieval in each rejected case might have been possible.
Results: Among the 128 potential donor referrals, 20 donors (15.6%) underwent liver retrieval. Of the 20 livers retrieved, 16 were implanted and 4 were not implanted (3 unfit recipients, and 1 donor liver with 40% steatosis). Another 10 donor livers were assessed intraoperatively and were rejected because of varying levels of steatosis. Of these livers assessed, 5 donor livers had steatosis <40% and 5 had steatosis >40%. Of the remaining potential donors, 45 were deemed not possible because of prolonged hypotension (9), on-going or unresolved sepsis (13), high-risk behaviour (4), non-actualisation (8), or pre-existing medical conditions (11). Another 53 donors may potentially have been suitable donors but were rejected because of possible sepsis (13), no suitable recipients (12), transient hypotension (10), transient abnormal liver function test (6), history of alcohol ingestion (5), non-actualisation because of consent (4) and other reasons (3). Overall, it was deemed that 61 donors (47.7%) might potentially have been suitable liver donors.
Conclusions: Despite new legislation (HOTA) in Singapore, the utilisation of cadaveric donor livers showed no increase in the last 3 years. By expanding our donor criteria to include marginal donors, we could potentially increase the availability of deceased donor livers to meet our waiting list demands.
Key words: Liver transplant, Marginal livers, New legislation, Opt-out scheme
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37
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Haddad H, Isaac D, Legare JF, Pflugfelder P, Hendry P, Chan M, Cantin B, Giannetti N, Zieroth S, White M, Warnica W, Doucette K, Rao V, Dipchand A, Cantarovich M, Kostuk W, Cecere R, Charbonneau E, Ross H, Poirier N. Canadian Cardiovascular Society Consensus Conference update on cardiac transplantation 2008: Executive Summary. Can J Cardiol 2009; 25:197-205. [PMID: 19340342 PMCID: PMC2706756 DOI: 10.1016/s0828-282x(09)70061-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 12/21/2008] [Indexed: 12/13/2022] Open
Affiliation(s)
- H Haddad
- University of Ottawa Heart Institute, Ottawa, Canada.
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38
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Sumethkul V, Ingsathit A, Jirasiritham S. Ten-year follow-up of kidney transplantation from hepatitis B surface antigen-positive donors. Transplant Proc 2009; 41:213-5. [PMID: 19249516 DOI: 10.1016/j.transproceed.2008.09.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 09/18/2008] [Indexed: 02/08/2023]
Abstract
Hepatitis B surface antigen positivity (HBsAg(+)) was believed to be an exclusion for kidney donation. However, in the presence of an organ shortage, allocation of kidneys from HBsAg(+) donors to recipients with anti-HBsAb(+) might be allowed. We examined the 10-year outcomes of kidney transplants (KT) from HBsAg(+) donors to natural or vaccine-induced anti-HBsAb(+) recipients (Group 1). Hepatitis B hyperimmune globulin (HBIG) and lamivudine were not used at any time. We compared the 10-year outcomes of patients who had HBsAg(+) prior to KT and received kidneys from HBsAg(-) donors (Group 2). The endpoint was patient survival determined by Kaplan-Meier and Cox proportional hazard methods. A total of 41 patients were transplanted from 1991-1997. There were 14 Group 1 patients and 27 Group 2 patients. Anti-HBsAb titer ranged from 10 to >1000 mIU/mL. Actuarial 10-year patient survivals were 92.8% and 62.5% for Group 1 and Group 2. Only 1 patient in Group 1 died; this case was due to an acute myocardial infarction. Eleven deaths occurred among Group 2; they were due to chronic active hepatitis (n = 5), hepatoma (n = 3), acute fibrosing cholestatic hepatitis (n = 1), and stroke (n = 2). More than 2 times elevated ALT occurred among 45% of Group 2 but none in Group 1. No patients in Group 1 had positive HBsAg and HBV DNA at last follow-up. Four patients in Group 2 displayed seroconversion to positive HBeAg after KT. Secondary analysis examining the impact of KT on patient life expectancy (from the start of dialysis until last follow-up) used Cox regression, revealing that KT was significantly associated with an increased risk for death within 12 months after transplantation (RR = 30, P = .005) but a decreased risk for death thereafter (RR = .03, P = .005) for Group 2. However, KT did not have significant impact on the risk for death within the first year for Group 1 (P = .61). Our results showed that the 10-year survival of KT from HBsAg(+) donors to recipients with anti-HBsAb(+) was good. This was not associated with evidence of active liver disease. The presence of HBsAg(+) in donors thus should not be considered an exclusion for kidney donation for anti-HBsAb(+) recipients.
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Affiliation(s)
- V Sumethkul
- Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand
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39
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Ersoy O, Yilmaz R, Arici M, Turgan C, Bayraktar Y. Prevalence of Occult Hepatitis B Infection in Hemodialysis Patients. DIALYSIS & TRANSPLANTATION 2008; 37:362-368. [DOI: 10.1002/dat.20258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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40
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Wei HK, Loong CC, King KL, Wu CW, Lui WY. HBsAg(+) Donor as a Kidney Transplantation Deceased Donor. Transplant Proc 2008; 40:2097-9. [DOI: 10.1016/j.transproceed.2008.07.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Weikert BC, Blumberg EA. Viral infection after renal transplantation: surveillance and management. Clin J Am Soc Nephrol 2008; 3 Suppl 2:S76-86. [PMID: 18309006 DOI: 10.2215/cjn.02900707] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Viral infections remain a significant cause of morbidity and mortality following renal transplantation. Although cytomegalovirus is the most common opportunistic pathogen seen in transplant recipients, numerous other viruses have also affected outcomes. In some cases, preventive measures such as pretransplant screening, prophylactic antiviral therapy, or post transplant viral monitoring may limit the impact of these infections. Recent advances in laboratory monitoring and antiviral therapy have improved outcomes. This review will summarize the major viral infections seen following transplant and discuss strategies for prevention and management of these potential pathogens.
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Affiliation(s)
- Blair C Weikert
- Hospital of the University of Pennsylvania, Division of Infectious Diseases, 3400 Spruce Street, 3 Silverstein, Suite E, Philadelphia, PA 19104, USA.
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42
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Castón JJ, Cisneros JM, Torre-Cisneros J. [Effects of viral infection on transplant recipients]. Enferm Infecc Microbiol Clin 2008; 25:535-48. [PMID: 17915112 PMCID: PMC7130329 DOI: 10.1157/13109990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Viral infection remains an important cause of morbidity and mortality in transplant recipients. The risk of viral infection in these patients depends on several factors, such as the type of organ transplanted, the intensity of immunosuppression, and the recipient's susceptibility. In additional to direct effects, viral infection cause indirect effects, including greater risk of replication of other viruses, graft rejection, opportunistic infections and other specific entities for each type of transplant. These indirect effects result from the immunomodulatory activity of some viruses, such as cytomegalovirus and human herpes virus-6. For the most part, quantitative molecular tests have replaced serologic testing and in vitro culture for diagnosing infection. This approach is particularly prominent for cytomegalovirus, Epstein-Barr virus, hepatitis B virus, and hepatitis C virus. Despite these diagnostic advances, the development of specific antiviral agents and effective antiviral vaccines is limited. Thus, prophylactic strategies are still essential in transplant recipients.
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Affiliation(s)
- Juan José Castón
- Unidad Clínica de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Córdoba. España
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43
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Wörns MA, Teufel A, Kanzler S, Shrestha A, Victor A, Otto G, Lohse AW, Galle PR, Höhler T. Incidence of HAV and HBV infections and vaccination rates in patients with autoimmune liver diseases. Am J Gastroenterol 2008; 103:138-46. [PMID: 17970833 DOI: 10.1111/j.1572-0241.2007.01609.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Hepatitis A virus (HAV) or hepatitis B virus (HBV) superinfection is associated with an increased mortality in patients with chronic liver diseases (CLD). Despite official recommendations, it was reported that the vaccination rate against HAV is low in patients with chronic hepatitis C infection. To evaluate the situation in patients with autoimmune liver diseases, we conducted a retrospective cohort study. METHODS Susceptibility to HAV and HBV infections, course of HAV and HBV infections, vaccination rates against HAV and HBV, and efficacy of hepatitis A/B vaccines were evaluated by antibody testing in 225 patients with autoimmune liver diseases during 1,677 person-years. RESULTS Susceptibility to HAV/HBV infection was 51/86%. Incidence of HAV/HBV infection was 1.3/1.4 per 1,000 person-years. One HAV infection occurred, but the patient recovered spontaneously. Two patients were HBV-infected after receiving an anti-HBc-positive (antibody to hepatitis B core antigen) donor graft during orthotopic liver transplantation, and one of them developed chronic HBV infection. Vaccination rates were 11% (HBV) and 13% (HAV), respectively. Seventy-six percent of the vaccinated patients (HBV vaccine) developed anti-HBs (antibody to hepatitis surface antigen) >or=10 UI/L. Ten out of 13 vaccinated patients, showing a low or nonresponse to hepatitis B vaccine, had concomitant immunosuppressive therapy. Anti-HAV was detectable in all patients after administration of HAV vaccine. CONCLUSIONS Patients with autoimmune liver diseases have a high susceptibility to HAV and HBV infections. Vaccination rates are low in this patient cohort and efficacy of hepatitis B vaccine is reduced due to immunosuppressive therapy. Improving adherence to vaccine recommendations is essential to prevent HAV and HBV infections in patients with autoimmune liver diseases.
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Affiliation(s)
- Marcus A Wörns
- Department of Internal Medicine I, Johannes Gutenberg-University, Mainz, Germany
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Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: what clinicians need to know. Am J Transplant 2008; 8:9-14. [PMID: 18093271 DOI: 10.1111/j.1600-6143.2007.02051.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Vaccine-preventable diseases remain a major source of morbidity and mortality in transplant recipients. Since the publication of the American Society of Transplantation's guidelines for vaccination of solid organ transplant recipients in 2004 (1), several new vaccines have been licensed. Transplant clinicians have been inundated by questions from patients and colleagues regarding the utility and safety of these vaccines in transplant candidates and recipients. In addition, new data has appeared regarding utility of some established vaccines, lack of rejection after vaccination and newer adjuvant strategies. Literature published between 2004 and 2007 was reviewed in a Medline search. Guidelines from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices are reviewed and summarized, with particular attention to vaccines for human papillomavirus, varicella and varicella-zoster, tetanus-reduced diphtheria-acellular pertussis (Tdap) and hepatitis B, as well as conjugated meningococcal and conjugated pneumococcal vaccines. Although randomized controlled trials in transplant recipients have not been performed for most new licensed vaccines, preliminary recommendations can be formulated based on current data and guidelines. Further studies will be important to determine the indications and optimal timing of newer immunizations and immunization strategies.
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Affiliation(s)
- R K Avery
- Section head, Transplant Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
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Abstract
The defence response to infectious agents is compromised in solid organ recipients because of their immunosuppressive treatment. Transmission of infection from a donor organ can result in dysfunction or loss of the allograft, and may lead to death of the recipient if adequate preventive measures are not taken. This potential risk should be thoroughly assessed, particularly in the case of organs from infected donors, in order to optimize organ use without increasing the incidence of graft dysfunction and recipient morbidity and mortality. This article reviews the current knowledge regarding screening for infection in potential donors and discusses risk-benefit considerations related to the use of organs from infected donors.
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Affiliation(s)
- Oscar Len
- Servicio Enfermedades Infecciosas, Hospital Vall d'Hebron, Barcelona, España.
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Mawhorter SD, Avery RK. Can Donors With Prior Hepatitis Be Safely Used for Heart Transplantation? J Heart Lung Transplant 2006; 25:805-13. [PMID: 16818123 DOI: 10.1016/j.healun.2006.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 02/23/2006] [Accepted: 03/02/2006] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Heart transplantation represents a significant life-saving and increased quality-of-life intervention for patients with refractory cardiac failure. Successful transplantation requires continuous immunosuppression to avoid immune rejection. Unfortunately, persistent viral infections in donors may be transmitted to recipients in the process of heart transplantation. With the severe shortage of available organs and significant waiting list mortality there is a rationale for considering use of organs from donors with evidence of prior hepatitis B and/or hepatitis C infection. METHODS Published literature articles were searched using Medline, PaperChase and further review of references in relevant articles on issues related to hepatitis B and hepatitis C and heart transplantation. RESULTS Donor and recipient testing for hepatitis B and hepatitis C is important for relative risk assessment. Nucleic acid testing for hepatitis B DNA and hepatitis C RNA represent emerging technologies, which may add valuable information to traditional serologic testing. CONCLUSIONS Heart transplant recipient risk may be modified by vaccination against hepatitis B before transplantation. There is currently no available vaccine for hepatitis C. Recently described effective treatments for hepatitis B and hepatitis C provide further rationale for reconsideration of using hearts from donors with evidence of hepatitis B and/or hepatitis C infection.
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Affiliation(s)
- Steven D Mawhorter
- Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Abstract
HBV infection in the absence of HBsAg has been a matter of debate for years, but its existence and clinical relevance are now supported by many publications, editorials and reviews. HBV DNA without HBs antigenemia was detected in the following clinical situations: (1) Chronic, presumably viral, hepatitis unrelated to HCV, atypical alcoholic hepatitis and hepatocellular carcinoma (HCC); (2) viral reactivation following immunosuppression; (3) Transmission through transplantation, transfusion or experimental transmission to chimpanzees. Occult HBV infections are not restricted to areas of high HBV endemicity. Indeed, such cases have been described in Western countries including France. It is now established that occult HBV infection among non-HCV patients suffering from chronic hepatitis varies from 20% to 30% in Europe, and in the context of HCV infection it varies from 20% in France up to 80% in Japan. The percentage of occult HBV infections among non A-E cases depends on several parameters: (1) The method of detection, including PCR primer selection; (2) patient recruitment; (3) patients from countries highly endemic for HBV are more likely to develop occult HBV infections; (4) prevalence may also vary depending on the nature of biological material tested, with a higher proportion for liver compared to serum specimen. The mechanisms leading to HCC in occult HBV infection seem similar to those overt cases, patients with low-grade but diagnosable HBV replication that retains its pro-oncogenic properties. During the course of HCV infection, occult HBV infection may worsen liver damage induced by HCV and reduce the response to HCV antiviral treatment. Occult HBV infection is a frequent phenomenon and HBV DNA testing with highly sensitive PCR in the clinical setting is therefore becoming of paramount importance.
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Affiliation(s)
- I Chemin
- Inserm U271 151 Crs A Thomas, 69003 Lyon, France
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Berber I, Aydin C, Yigit B, Turkmen F, Titiz IM, Altaca G. The effect of HBsAg-positivity of kidney donors on long-term patient and graft outcome. Transplant Proc 2006; 37:4173-5. [PMID: 16387070 DOI: 10.1016/j.transproceed.2005.10.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Indexed: 12/11/2022]
Abstract
The number of patients on the kidney waiting list is increasing, creating a shortage of donor organs. To solve this problem, there is an interest in transplanting organs formerly considered marginal or undesirable. We performed seven (four living related, three cadaveric) kidney transplants from hepatitis B surface antigen (HBsAg)-positive donors. Hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA were negative in the living donors and were unknown in cadaveric donors. Liver function tests were in the normal range in all of the donors. All of the recipients were HBsAg-negative and hepatitis B surface antibody (anti-HBs)-positive. Recipients receiving kidneys from cadaveric donors were given prophylactic lamivudine treatment postoperatively. Anti-HBs remained positive throughout the follow-up period in all but one patient with a cadaveric graft. None of the patients receiving a kidney from an HBsAg-positive donor developed clinical HBV infection in a mean follow-up period of 42.6 +/- 36.8 months (range: 16 to 121 months, median 30 months). Liver function tests remained in the normal ranges in all patients. All the grafts are still functioning with a mean serum creatinine level of 1.6 +/- 0.85 mg/dL. In conclusion, transplants from HBsAg-positive and HBeAg-/HBV DNA-negative donors seem to carry no risk to the recipients who are immune to HBV. Even cadaveric donors with HBsAg-positivity and unknown HBeAg/HBV DNA status can be used with caution in selected recipients without significantly affecting graft and patient outcome.
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Affiliation(s)
- I Berber
- Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.
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Haji SA, Avery RK, Yamani MH, Tuzcu EM, Crowe TD, Cook DJ, Mawhorter SD, Hobbs R, Young JB, Smedira N, Starling RC. Donor or Recipient Hepatitis B Seropositivity Is Associated With Allograft Vasculopathy. J Heart Lung Transplant 2006; 25:294-7. [PMID: 16507422 DOI: 10.1016/j.healun.2005.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 08/18/2005] [Accepted: 10/13/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Increasing interest has focused on possible viral triggers of cardiac allograft vasculopathy. Although much interest has centered on cytomegalovirus, it has recently been noted that donor hepatitis C seropositivity is associated with risk for accelerated vasculopathy. The current study hypothesized that hepatitis B (HBV) might be associated with accelerated vasculopathy. METHODS Sixty-six patients who received heart transplants between September 1998 and July 2000 were analyzed by intravascular ultrasound within 6 weeks and again at 12 months after transplantation. These patients were divided into 2 groups: the HBV Group (n = 13) in which either the donor or recipient was seropositive for hepatitis B core antibody (HBcAb), and a Control Group (n = 53) in which neither donor nor recipient was positive for HBcAb. RESULTS Baseline characteristics of the 2 groups were similar. The HBV Group had significant increase in the change in average intimal area (1.59 +/- 1.4 vs 0.46 +/- 0.4 mm2, p = 0.01) per mm length of the vessel compared with controls. Allograft vasculopathy at 1 year (defined as largest maximal intimal thickness increase of > or =0.50 mm) occurred in 46% of the HBV group compared with 24% of the control group (p = 0.05). When measured as an average maximal intimal thickness increase of >0.30 mm, allograft vasculopathy at 1 year occurred in 31% of the HBV Group compared with 5% of Controls (p = 0.01). CONCLUSIONS These preliminary results suggest that HBV seropositivity in donor or recipient may be associated with an increased risk for cardiac allograft vasculopathy.
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Affiliation(s)
- Showkat A Haji
- Department of Cardiology, Tulane University Medical Center, New Orleans, Louisiana 70112, USA.
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Feng S. Selecting livers for transplantation: can beggars be choosers? NATURE CLINICAL PRACTICE. GASTROENTEROLOGY & HEPATOLOGY 2005; 2:496-7. [PMID: 16355138 DOI: 10.1038/ncpgasthep0312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Accepted: 09/07/2005] [Indexed: 05/05/2023]
Affiliation(s)
- Sandy Feng
- University of California San Francisco, San Francisco, 94143, USA.
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