Utilization of Hepatitis B viremic donors (NAT+) leads to improved kidney transplant access for older adult recipients with little to no wait time

Background Though the use of Hepatitis B viremic (HBV) donor kidneys may be a safe alternative to improve access to transplantation, there has not been wide acceptance of this practice. In this study, we determined the safety and effectiveness of HBV NAT (+) donor kidneys in a protocolized manner in an older adult population. Methods Over a 3‐year period, 16 decreased donor kidney transplants were performed with HBV NAT+ kidneys. Recipients of HBV NAT+ kidneys were treated with entecavir started pre‐operatively and continued for 52 weeks. Results HBV NAT+ kidneys were preferentially used in older (68 ± 5 vs. 64 ± 9 years; p = .01) recipients with less dialysis time (93.8% < 5 years vs. 67% <5 years; p = .03). In this cohort, 3/16 had detectable HBV PCR 1‐week post‐transplant, but all were negative at 9‐ and 12‐months. Calculated estimated glomerular filtration rate (eGFR) was slightly decreased 12‐months post‐transplant. Post‐transplant outcomes in an age‐matched cohort showed no difference in rates of delayed graft function, readmission within 30 days, and graft loss or death within 6 months of transplant ( p > .05). Conclusion Transplants with HBV NAT+ donor kidneys in a pre‐emptive treatment protocol allow for increased safe access to transplantation in older adult recipients with little or no dialysis time.