Transplantation proceedings · 2026
Renal Outcomes in HBsAg-Positive Living Kidney Donors: A Retrospective Cohort Study.
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Huang Xia, Yin Saifu, Lin Tao
Аннотация
BACKGROUND: The utilization of hepatitis B surface antigen-positive (HBsAg+) living kidney donors is a strategy to expand the donor pool. However, concerns regarding their renal safety after nephrectomy persist due to the potential impact of chronic HBV infection on the solitary kidney.
METHODS: In this retrospective cohort study, we analyzed 415 living kidney donors, including 31 (7.5%) who were HBsAg+. Donors were followed for a mean duration of 46.81 months (HBsAg+ group) and 42.10 months (HBsAg- group). The primary outcome was the change in renal function, assessed by serum creatinine levels and the incidence of an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73m². Multivariable linear regression was used to identify factors associated with post-donation renal function change.
RESULTS: Baseline characteristics were comparable. At the last follow-up, there was no significant difference in serum creatinine between HBsAg+ and HBsAg- donors (81.65 µmol/L vs. 81.64 µmol/L, p = .996). The increase in creatinine from baseline was slightly greater in the HBsAg+ group (12.53 µmol/L vs. 11.08 µmol/L), but this difference was not statistically significant (p = .060). The incidence of low eGFR (<45 mL/min/1.73m²) was low in both groups (3.2% vs. 0.5%, p = .543), with no cases of end-stage kidney disease. Multivariable analysis confirmed that HBsAg+ status was not an independent predictor of serum creatinine increase (Estimate 1.42, 95% CI: -0.16 to 3.01; p = .078), whereas hypertension (Estimate 1.89, p = .039) and diabetes (Estimate 3.28, p = .016) were significant predictors.
CONCLUSION: Over an intermediate-term follow-up, carefully selected HBsAg+ living kidney donors did not exhibit a significantly higher risk of renal impairment compared to HBsAg- donors. HBsAg positivity itself was not an independent risk factor for renal function decline.
METHODS: In this retrospective cohort study, we analyzed 415 living kidney donors, including 31 (7.5%) who were HBsAg+. Donors were followed for a mean duration of 46.81 months (HBsAg+ group) and 42.10 months (HBsAg- group). The primary outcome was the change in renal function, assessed by serum creatinine levels and the incidence of an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73m². Multivariable linear regression was used to identify factors associated with post-donation renal function change.
RESULTS: Baseline characteristics were comparable. At the last follow-up, there was no significant difference in serum creatinine between HBsAg+ and HBsAg- donors (81.65 µmol/L vs. 81.64 µmol/L, p = .996). The increase in creatinine from baseline was slightly greater in the HBsAg+ group (12.53 µmol/L vs. 11.08 µmol/L), but this difference was not statistically significant (p = .060). The incidence of low eGFR (<45 mL/min/1.73m²) was low in both groups (3.2% vs. 0.5%, p = .543), with no cases of end-stage kidney disease. Multivariable analysis confirmed that HBsAg+ status was not an independent predictor of serum creatinine increase (Estimate 1.42, 95% CI: -0.16 to 3.01; p = .078), whereas hypertension (Estimate 1.89, p = .039) and diabetes (Estimate 3.28, p = .016) were significant predictors.
CONCLUSION: Over an intermediate-term follow-up, carefully selected HBsAg+ living kidney donors did not exhibit a significantly higher risk of renal impairment compared to HBsAg- donors. HBsAg positivity itself was not an independent risk factor for renal function decline.