The impact of hepatitis B and C positive serologies on the outcomes of non‐hepatic solid organ transplantation in the United States

Abstract

AbstractChronic viral hepatitis B (HBV) and C (HCV) infection could negatively affect outcomes of non‐hepatic solid organ transplantations due to the risk of viral reactivation in the presence of immunosuppression. This study aimed to determine post‐transplant outcomes in patients with HBV or HCV positivity receiving non‐hepatic solid‐state organ transplant. Data was collected from the Scientific Registry of Transplant Recipients (SRTR) 2006–2021 for patients (≥18) who received a lung, heart, or kidney single organ transplant in the U.S. Hepatitis C positivity (HCV+) was determined as positive HCV Ab and hepatitis B positivity (HBV+) as positive HBsAg. We included N = 30,872 lung, N = 36,990 heart and N = 280,162 kidney transplant recipients. The prevalence of HBV+ was 1.3% in lung, 1.5% in heart and 1.7% in kidney patients, HCV+ was 2.2%, 2.2% and 5.0%, respectively. Post‐transplant survival of patients with vs. without HBV+ was similar in all solid organ transplants (all p > .05). Similarly, there was no difference in post‐transplant survival between lung transplant recipients with vs. without anti‐HCV (all p > .05). Heart transplant recipients with HCV+ had higher crude post‐transplant mortality (all p < .01). Similarly, there was higher post‐transplant mortality in kidney transplant recipients with HCV+ (1‐year: 6% vs. 3%; 5‐year: 21% vs. 13%; 10‐year: 47% vs. 31%; all p < .0001). In multivariate analysis controlling for confounders, only the association of HCV+ with higher post‐kidney transplant mortality remained significant: adjusted hazard ratio (aHR) (95% CI) = 1.16 (1.12–1.20), p < .0001. There was no association of viral hepatitis seropositivity with the risk of graft failure in all groups (p > .05). In most cases, the presence of HBV or HCV serologies is not associated with adverse post‐transplant outcomes in non‐hepatic solid organ transplants. However, kidney transplant recipients who are positive for HCV serology have an increased risk for post‐transplant mortality.