| Donor HBV status | Recipient HBV serologic status | Kidney transplantation: Whether "to proceed" or "not to proceed" | Antiviral therapy* | Comments |
| Chronic infection | No evidence of immunity or infection | Avoid transplantation except in exceptional circumstances | Yes, if transplanted | - May administer hepatitis B immune globulin in addition to antiviral therapy to prevent de novo infection.
- Recipients should be vaccinated if they have no prior immunity, although the efficacy in eliciting an anti-HBs response is reduced due to the effect of immunosuppressive medications.
- The optimal duration of antiviral therapy is unknown; we administer therapy for 1 year.
|
| Immunity due to vaccination (anti-HBs ≥10 mIU/mL) | Yes | Yes | - Administer antiviral therapy to prevent de novo infection because anti-HBs titer can decrease and become undetectable with immunosuppression.
- The role of hepatitis B immunoglobulin is uncertain but may be considered perioperatively if the anti-HBs level is below 100 mIU/mL.
- In recipients with immunity from vaccination, we check the anti-HBs titer prior to discontinuing antiviral therapy and administer a booster dose of vaccine if the titer is <10 mIU/mL.
- The optimal duration of antiviral therapy is unknown; we administer therapy for 1 year.
|
| Prior infection | Yes | Yes | - Recipients who are anti-HBc positive have evidence of prior infection, and HBV reactivation may occur secondary to immunosuppressive therapy. The presence of anti-HBs at time of transplantation may not prevent reactivation, because anti-HBs titer can decrease and become undetectable with immunosuppression.
- The duration of antiviral therapy can vary. Some centers administer antiviral therapy indefinitely to all recipients with prior HBV. Others discontinue treatment when immunosuppression is reduced to low-dose maintenance level and monitor closely thereafter, unless the patient is receiving immunosuppression with an agent associated with a high risk of HBV reactivation (eg, rituximab).¶
|
| Chronic infection | Yes | Yes | - Administer lifelong antiviral therapy to prevent reactivation of HBV secondary to immunosuppressive therapy.Δ
|
| Prior infection | No evidence of immunity or infection | Yes | No, unless donor has detectable HBV viral load | - Recipients should be vaccinated if they have no prior immunity, although the efficacy in eliciting an anti-HBs response is reduced due to the effect of chronic kidney disease and immunosuppressive medications.
- If antiviral therapy is administered, the optimal duration is unknown; we administer therapy for 1 year.
|
| Immunity due to vaccination (anti-HBs ≥10 mIU/mL) | Yes | No, unless donor has detectable HBV viral load | - If antiviral therapy is administered, the optimal duration of antiviral therapy is unknown; we administer therapy for 1 year.
- In recipients with immunity from vaccination, we check the anti-HBs titer prior to discontinuing antiviral therapy and administer a booster dose of vaccine if the titer is <10 mIU/mL.
|
| Prior infection | Yes | Yes | - Recipients who are anti-HBc positive have evidence of prior infection and need antiviral therapy to prevent HBV reactivation secondary to immunosuppressive therapy. The presence of anti-HBs at time of transplantation may not prevent reactivation, because anti-HBs titer can decrease and become undetectable with immunosuppression.
- The duration of antiviral therapy can vary. Some centers administer antiviral therapy indefinitely to all recipients with prior HBV. Others discontinue treatment when immunosuppression is reduced to low-dose maintenance level and monitor closely thereafter, unless the patient is receiving immunosuppression with an agent associated with a high risk of HBV reactivation (eg, rituximab).¶
|
| Chronic infection | Yes | Yes | - Administer life-long antiviral therapy to prevent reactivation of HBV secondary to immunosuppressive therapy.Δ
|
| No evidence of prior infection◊ | No evidence of immunity or infection | Yes | No | |
| Immunity due to vaccination | Yes | No | |
| Prior infection | Yes | Yes | - Recipients who are anti-HBc positive have evidence of prior infection and may need antiviral therapy to prevent HBV reactivation secondary to immunosuppressive therapy. The presence of anti-HBs at time of transplantation may not prevent reactivation, because anti-HBs titer can decrease and become undetectable with immunosuppression.
- The duration of antiviral therapy can vary. Some centers administer antiviral therapy indefinitely to all recipients with prior HBV. Others discontinue treatment when immunosuppression is reduced to low-dose maintenance level and monitor closely thereafter, unless the patient is receiving immunosuppression with an agent associated with a high risk of HBV reactivation (eg, rituximab).¶
|
| Chronic infection | Yes | Yes | - Administer life-long antiviral therapy to prevent reactivation of HBV secondary to immunosuppressive therapy.Δ
|
