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A Rare Case of Kidney Transplantation from Hepatitis B Positive Donor to Hepatitis B Negative Recipient

Runderawala, Hozefa

doi: 10.1097/01.tp.0000520315.48713.67
116.12
Free

General Medicine, Saifee Hospital, Mumbai, India.

Introduction: 27-year-old male was diagnosed with chronic kidney disease 4 years back, kidney biopsy suggestive of crescentic glomerulonephritis, was on maintenance hemodialysis through arteriovenous fistula. Progressively his disease worsened and was not able to maintain on hemodialysis and advised for kidney transplantation. HLA matching was done and was found to be matched with his mother. Incidentally his mother found to be Hepatitis B surface antigen (HBsAg) positive and he was negative for the same. Anti HBs titer of the recipient was done and it was increased to more than 1000mIU/L by giving hepatitis B vaccination. As patient could not afford intravenous immunoglobulins, he was administered hepatitis B vaccination. The Hepatitis B viral load of the donor was done, she was given prophylactically antiviral treatment and the viral load was brought to an undetectable level.

Methods: Since the first successful kidney transplantation in 1954, there has been exponential growth in the number of kidney transplantation. Hepatitis B virus is an established cause of morbidity and mortality in kidney transplant recipients [5]. It is generally accepted that transplanting an HBsAg positive allograft into an HBsAg negative recipient carries a significant risk of de novo infection [6]. The renal transplantation of HIV positive and Hepatitis C positive patient is taking place worldwide. But in Hepatitis B positive patient, it has not been studied much. However, the rapid increase in end stage renal disease patients has exacerbated the shortage of donor organs. There are many reports of kidney transplantation from Hepatitis B positive recipient to Hepatitis B positive donor. But in our case, we have transplanted a living donor kidney from hepatitis B positive to Hepatitis B negative recipient.

Results: The donor was treated with antiviral drugs pre-transplant and her viral load was brought to an undetectable level, minimizing the chance of transmission of HBV. To further reduce the risk of transmission, the recipient was hyperimmunised with hepatitis B vaccination and to get his anti HBs titer > 100IU/L. After achieving the targets in both recipient and donor, successful kidney transplantation was performed.

Conclusion: Follow up Hepatitis B surface antigen (HBsAg) of the recipient was done after 3 months which was negative.

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2. Schnuelle P, Lorenz D, Trede M, Van Der Woude FJ. J Am Soc Nephrol. 1998;9(11):2135.

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4. Ojo Ao, Port FK, Wolfe RA, Mauger EA, Williams L, Berling DP. Am J Kidney Dis. 1994;24(1):59.

5. Fabrizi F, Lunghi G, Poordad FF, Martin P. J Nephrol. 2002;15:113-122.

6. Lutwick LI, Sywassink JM, Corry RJ, Shorey JW. Clin Nephrol. 1983;19:317-319.

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