Hepatitis B

1. HBsAg -, HBcAb + renal transplant recipients

Before renal transplant surgery, if time allows, check the HBsAb levels and give a booster dose if levels are <10 mIU/mL; otherwise, give a booster dose regardless of HBsAb levels unless one was given in the previous 8 weeks.
Monitor HBsAg monthly for the first 3 months post-transplantation, and every 3-4 months subsequently for at least a year.
If rituximab is being used (e.g. in ABO incompatible transplantation), lamivudine 100mg daily for 12 months should be used due to a high risk of virus reactivation. Data are unclear for ATG, but lamivudine could be considered in this situation. Discussion with hepatology is suggested and Dr Bathgate is happy to be contacted in the first instance.

2. HBsAg -, HBcAb- renal transplant recipient with HBsAg -, HBcAb + donor

The risk is lower in this circumstance compared to recipient HBcAb+ cases as the virus resides in hepatocyte nuclei so transmission risk is low.
Before renal transplant surgery, if time allows, check the HBsAb levels and give a booster dose if levels are <10 mIU/mL; otherwise, give a booster dose regardless of HBsAb levels unless one was given in the previous 8 weeks.
HBV immunoglobulin (HBIG) is not necessary.
Monitor HBsAg monthly for the first 3 months post-transplantation, and every 3-4 months subsequently for at least a year.