Diagnosis of airway infection in organ donors: impact on successful lung transplantation

Objective: Hepatitis B core antibody positive (HBcAb ) and hepatitis C antibody (HCAb ) positive donors represents one strategy to increase the supply of available donor organs but remains controversial because of concern for viral transmission to recipients. We hypothesized that donors with HBcAb but negative HBsAg represent minimal risk of viral transmission in previously vaccinated lung transplant(LTxp) recipients. Method: A retrospective study using medical records of all LTxp recipients at Duke who received HBcAb and HCAb donor pulmonary allografts. Data analyzed include demographics, immunosuppressive regimen, liver function studies, viral hepatitis screen, quantitative PCR for hepatitis B viral DNA(PCRHBDNA), hepatitis C viral RNA(PCR-HCRNA), and survival. Hepatitis C organs were only transplanted into patients who agreed to accept such donors. Survival estimates were calculated using the Kaplan-Meier method and compared using the LogRank test. Results: Between April 1992 and August 2001, 353 LTxps operations were performed. All patients were immunized with hepatitis B vaccine prior to transplantation. 20 patients (HB group, 12 females and 8 males) underwent HBcAb allograft transplants with median posttransplant follow-up of 16 months. 3 patients (HC group, 1 female and 2 males) received HCAb donor allografts with median follow-up of 40 months. Maintenance immunosuppression included standard triple drug therapy without prophylactic treatment for hepatitis. One-year survival for HB group is 75% versus 79% for all patients who received non-HB donors LTxp cohort (p-value 0.88). No patient in HB group developed clinical liver disease due to viral hepatitis and all patients alive(n 13) at follow-up are to date PCR-HBDNA negative. All HC group patients tested PCR-HCRNA positive; 1 patient died of liver failure at 22 months. Conclusion: Risk of viral transmission with HCAb allografts appears high after lung transplantation. The use of HBcAb donor pulmonary allografts in recipients with prior hepatitis B vaccination appears safe and effective strategy to increase organ availability.