Management of Patient With Kidney Allograft From Asymptomatic Hepatitis B Virus Surface Antigen-Positive Donor

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ASK THE EXPERT

Management of Patient With Kidney Allograft From Asymptomatic Hepatitis B

Virus Surface Antigen-Positive Donor

Question

A kidney allograft from an asymptomatic hepatitis B virus (HBV) surface

antigen (HBsAg)-positive donor was transplanted into a recipient who was

HBsAb-positive. The recipient was vaccinated for HBV. What is the expected

course? Should we give immunoglobulin for HBV or lamivudine to the recipient

before transplantation? Is there a risk for acute HBV infection in the

recipient?

Hilmi Dikici, MD

Response from Roshan Shrestha, MD

Assistant Professor of Medicine, Associate Director of Transplant

Hepatology, Medical Director, Liver Transplantation Program University of

North Carolina, Chapel Hill, NC.

This is a very good question. It is important to know the status of viral

replication in the donor. If the donor is actively replicating HBV DNA, then

one should consider using HBIg at least during the surgery and for a few

days postoperatively to block the viral particles that may be transplanted

with the organ, and then you should use lamivudine to suppress the virus.

The optimal duration of therapy is not known; however, if the recipient is

persistently HBsAb-positive, one could discontinue treatment after several

months to a year. If the donor is not actively replicating the virus, then

lamivudine alone and monitoring serologies should be sufficient.

Posted 04/09/2004

----------------------------------------------------------------------------

Disclosure: Roshan Shrestha, MD, has no significant financial interests to

disclose.

Medscape Transplantation 5(1), 2004. © 2004 Medscape

[Guest guest]

MEDSCAPE

ASK THE EXPERT

Management of Patient With Kidney Allograft From Asymptomatic Hepatitis B

Virus Surface Antigen-Positive Donor

Question

A kidney allograft from an asymptomatic hepatitis B virus (HBV) surface

antigen (HBsAg)-positive donor was transplanted into a recipient who was

HBsAb-positive. The recipient was vaccinated for HBV. What is the expected

course? Should we give immunoglobulin for HBV or lamivudine to the recipient

before transplantation? Is there a risk for acute HBV infection in the

recipient?

Hilmi Dikici, MD

Response from Roshan Shrestha, MD

Assistant Professor of Medicine, Associate Director of Transplant

Hepatology, Medical Director, Liver Transplantation Program University of

North Carolina, Chapel Hill, NC.

This is a very good question. It is important to know the status of viral

replication in the donor. If the donor is actively replicating HBV DNA, then

one should consider using HBIg at least during the surgery and for a few

days postoperatively to block the viral particles that may be transplanted

with the organ, and then you should use lamivudine to suppress the virus.

The optimal duration of therapy is not known; however, if the recipient is

persistently HBsAb-positive, one could discontinue treatment after several

months to a year. If the donor is not actively replicating the virus, then

lamivudine alone and monitoring serologies should be sufficient.

Posted 04/09/2004

----------------------------------------------------------------------------

Disclosure: Roshan Shrestha, MD, has no significant financial interests to

disclose.

Medscape Transplantation 5(1), 2004. © 2004 Medscape

[Guest guest]

MEDSCAPE

ASK THE EXPERT

Management of Patient With Kidney Allograft From Asymptomatic Hepatitis B

Virus Surface Antigen-Positive Donor

Question

A kidney allograft from an asymptomatic hepatitis B virus (HBV) surface

antigen (HBsAg)-positive donor was transplanted into a recipient who was

HBsAb-positive. The recipient was vaccinated for HBV. What is the expected

course? Should we give immunoglobulin for HBV or lamivudine to the recipient

before transplantation? Is there a risk for acute HBV infection in the

recipient?

Hilmi Dikici, MD

Response from Roshan Shrestha, MD

Assistant Professor of Medicine, Associate Director of Transplant

Hepatology, Medical Director, Liver Transplantation Program University of

North Carolina, Chapel Hill, NC.

This is a very good question. It is important to know the status of viral

replication in the donor. If the donor is actively replicating HBV DNA, then

one should consider using HBIg at least during the surgery and for a few

days postoperatively to block the viral particles that may be transplanted

with the organ, and then you should use lamivudine to suppress the virus.

The optimal duration of therapy is not known; however, if the recipient is

persistently HBsAb-positive, one could discontinue treatment after several

months to a year. If the donor is not actively replicating the virus, then

lamivudine alone and monitoring serologies should be sufficient.

Posted 04/09/2004

----------------------------------------------------------------------------

Disclosure: Roshan Shrestha, MD, has no significant financial interests to

disclose.

Medscape Transplantation 5(1), 2004. © 2004 Medscape

[Guest guest]

MEDSCAPE

ASK THE EXPERT

Management of Patient With Kidney Allograft From Asymptomatic Hepatitis B

Virus Surface Antigen-Positive Donor

Question

A kidney allograft from an asymptomatic hepatitis B virus (HBV) surface

antigen (HBsAg)-positive donor was transplanted into a recipient who was

HBsAb-positive. The recipient was vaccinated for HBV. What is the expected

course? Should we give immunoglobulin for HBV or lamivudine to the recipient

before transplantation? Is there a risk for acute HBV infection in the

recipient?

Hilmi Dikici, MD

Response from Roshan Shrestha, MD

Assistant Professor of Medicine, Associate Director of Transplant

Hepatology, Medical Director, Liver Transplantation Program University of

North Carolina, Chapel Hill, NC.

This is a very good question. It is important to know the status of viral

replication in the donor. If the donor is actively replicating HBV DNA, then

one should consider using HBIg at least during the surgery and for a few

days postoperatively to block the viral particles that may be transplanted

with the organ, and then you should use lamivudine to suppress the virus.

The optimal duration of therapy is not known; however, if the recipient is

persistently HBsAb-positive, one could discontinue treatment after several

months to a year. If the donor is not actively replicating the virus, then

lamivudine alone and monitoring serologies should be sufficient.

Posted 04/09/2004

----------------------------------------------------------------------------

Disclosure: Roshan Shrestha, MD, has no significant financial interests to

disclose.

Medscape Transplantation 5(1), 2004. © 2004 Medscape