US sees uptick in ‘unexpected’ HBV infection in liver transplant recipients
There was a recent increase in “unexpected” hepatitis B virus infections among liver transplant recipients who received organs from donors who tested negative, according to findings published in MMWR.
Most of the donors were positive for hepatitis C virus and had a history of injection drug use, researchers reported.
“Recipients with signs or symptoms of liver injury after transplantation should be tested for viral hepatitis, even if previous HBV or hepatitis C testing was negative,” Danae Bixler, MD, from the CDC’s Division of Viral Hepatitis, and colleagues wrote. “More broadly, providers caring for recipients of organs from donors who recently injected drugs or are HCV seropositive should maintain awareness of infectious complications of drug use and monitor recipients accordingly.”
Bixler and colleagues examined 20 reports between 2014 and 2019 of HBV infection among transplant recipients who received livers from donors with no evidence of past or current HBV infection. They reviewed laboratory and medical record data for each recipient.
They found that 14 of the 20 cases were detected in 2019 alone, a median of 38 weeks following transplantation. Of the 14 donors, 13 tested positive for HCV and had a history of injection drug use within a year of their death, a positive toxicology result or both.
The researchers did not find behavioral risks or health care-associated HBV outbreaks for any reported cases. HBV vaccination status was not available for most recipients.
“HBV infection among transplant recipients can occur from reactivation of previous HBV infection, primary infection after transplantation, or donor-derived transmission,” the authors wrote. “This report provides evidence that transmission of HBV from donors occurred despite negative organ donor HBV DNA, [hepatitis B surface antigen], and total anti-[hemoglobin C] results before organ procurement.”