Abstract：
BACKGROUND: Better access to direct-acting antiviral (DAA) therapy has broadened the utilization of hepatitis C virus (HCV) nucleic acid testing (NAT) positive organs with excellent outcomes. However, DAA therapy has been associated with hepatitis B virus (HBV) reactivation.
OBJECTIVE: To determine the risk of HBV transmission or reactivation with utilization of HBV core antibody positive (HBcAb+) and HCV NAT positive (HCV+) organs, which presumably required DAA therapy.
METHODS: The number of HBcAb+ donors with delineated HCV NAT status was obtained from the Organ Procurement and Transplantation Network (OPTN) database. The number of unexpected HBV infections from transplanted organs adjudicated as \"proven\" or \"probable\" transmission was obtained from the OPTN Ad Hoc Disease Transmission Advisory Committee database. A chart review of the donors of \"proven\" or \"probable\" cases was conducted.
RESULTS: From January 1, 2016, to December 31, 2021, 7735 organs were procured from 3767 HBcAb+ donors and transplanted into 7469 recipients; 545 (14.5%) donors were also HCV+. HBV transmission or reactivation occurred in seven recipients. The rate is not significantly different between recipients of HCV+ (0.18%, 2/1115) and the HCV NAT negative (HCV-) organs (0.08%, 5/6354) (p = 0.28) or between recipients of HCV+ and HCV- livers as well as non-liver organs. HBV transmission or reactivation occurred within a median of 319 (range, 41-1117) days post-transplant in the setting of missing, inadequate, or truncated prophylaxis.
CONCLUSIONS: HBV reactivation associated with DAA therapy for HBcAb+ HCV+ organs is less frequent than reported in the non-transplant population, possibly due to the common use of HBV prophylaxis in the at-risk transplant population.
OBJECTIVE: To determine the risk of HBV transmission or reactivation with utilization of HBV core antibody positive (HBcAb+) and HCV NAT positive (HCV+) organs, which presumably required DAA therapy.
METHODS: The number of HBcAb+ donors with delineated HCV NAT status was obtained from the Organ Procurement and Transplantation Network (OPTN) database. The number of unexpected HBV infections from transplanted organs adjudicated as \"proven\" or \"probable\" transmission was obtained from the OPTN Ad Hoc Disease Transmission Advisory Committee database. A chart review of the donors of \"proven\" or \"probable\" cases was conducted.
RESULTS: From January 1, 2016, to December 31, 2021, 7735 organs were procured from 3767 HBcAb+ donors and transplanted into 7469 recipients; 545 (14.5%) donors were also HCV+. HBV transmission or reactivation occurred in seven recipients. The rate is not significantly different between recipients of HCV+ (0.18%, 2/1115) and the HCV NAT negative (HCV-) organs (0.08%, 5/6354) (p = 0.28) or between recipients of HCV+ and HCV- livers as well as non-liver organs. HBV transmission or reactivation occurred within a median of 319 (range, 41-1117) days post-transplant in the setting of missing, inadequate, or truncated prophylaxis.
CONCLUSIONS: HBV reactivation associated with DAA therapy for HBcAb+ HCV+ organs is less frequent than reported in the non-transplant population, possibly due to the common use of HBV prophylaxis in the at-risk transplant population.
摘要：
背景：更好地获得直接作用抗病毒（DAA）治疗已经扩大了丙型肝炎病毒（HCV）核酸检测（NAT）阳性器官的利用，具有出色的结果。然而,DAA治疗与乙型肝炎病毒（HBV）再激活有关。
目的：为了确定利用HBV核心抗体阳性（HBcAb+）和HCVNAT阳性（HCV+）器官的HBV传播或再激活的风险，这可能需要DAA治疗。
方法：从器官获取和移植网络（OPTN）数据库中获得具有HCVNAT状态的HBcAb+供体的数量。从OPTN特设疾病传播咨询委员会数据库中获得了从移植器官裁定为“已证明”或“可能”传播的意外HBV感染的数量。对“已证实”或“可能”病例的捐赠者进行了图表审查。
结果：从2016年1月1日至2021年12月31日，从3767个HBcAb+供体中采购了7735个器官，并移植到7469个受体中；545个（14.5%）供体也是HCV+。7名受者发生HBV传播或再激活。HCV+接受者之间的比率没有显着差异（0.18％，2/1115）和HCVNAT阴性（HCV-）器官（0.08％，5/6354）（p=0.28）或在HCV和HCV-肝脏以及非肝脏器官的接受者之间。HBV传播或再激活发生在319的中位数内（范围，41-1117）在失踪的情况下进行移植后的几天，不足,或截断的预防。
结论：与HBcAb+HCV+器官的DAA治疗相关的HBV再激活比非移植人群报道的频率低。可能是由于在高危移植人群中普遍使用HBV预防。
目的：为了确定利用HBV核心抗体阳性（HBcAb+）和HCVNAT阳性（HCV+）器官的HBV传播或再激活的风险，这可能需要DAA治疗。
方法：从器官获取和移植网络（OPTN）数据库中获得具有HCVNAT状态的HBcAb+供体的数量。从OPTN特设疾病传播咨询委员会数据库中获得了从移植器官裁定为“已证明”或“可能”传播的意外HBV感染的数量。对“已证实”或“可能”病例的捐赠者进行了图表审查。
结果：从2016年1月1日至2021年12月31日，从3767个HBcAb+供体中采购了7735个器官，并移植到7469个受体中；545个（14.5%）供体也是HCV+。7名受者发生HBV传播或再激活。HCV+接受者之间的比率没有显着差异（0.18％，2/1115）和HCVNAT阴性（HCV-）器官（0.08％，5/6354）（p=0.28）或在HCV和HCV-肝脏以及非肝脏器官的接受者之间。HBV传播或再激活发生在319的中位数内（范围，41-1117）在失踪的情况下进行移植后的几天，不足,或截断的预防。
结论：与HBcAb+HCV+器官的DAA治疗相关的HBV再激活比非移植人群报道的频率低。可能是由于在高危移植人群中普遍使用HBV预防。
