Abstract: SA-PO1130
Dynamics of Hepatitis B Immunity After Kidney Transplantation
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Alanzi, Meshaal, Mayo Clinic Arizona, Phoenix, Arizona, United States
- Vikram, Holenarasipur R., Mayo Clinic Arizona, Phoenix, Arizona, United States
- Vargas, Hugo E., Mayo Clinic Arizona, Phoenix, Arizona, United States
- Jadlowiec, Caroline, Mayo Clinic Arizona, Phoenix, Arizona, United States
- Khamash, Hasan, Mayo Clinic Arizona, Phoenix, Arizona, United States
- Alasfar, Sami, Mayo Clinic Arizona, Scottsdale, Arizona, United States
Background
As programs use HBV NAT+ donors to expand the kidney pool, ensuring durable recipient immunity is critical. Kidney recipients face higher HBV risk due to immunosuppression and donor exposure. Although protection is defined as HBsAb ≥10 mIU/mL, post-transplant durability remains uncertain.
Methods
We performed a retrospective review of adult kidney-only transplant recipients (2020–2024). Pre-transplant HBsAb was measured in all; those with post-transplant levels within 1 year were analyzed. Protective immunity was HBsAb >10 mIU/mL. Patients were stratified by age and induction therapy. ROC analysis assessed how well pre-transplant HBsAb predicted post-transplant immunity loss.
Results
Among 2,189 kidney transplant recipients, 1,439 (65.7%) had protective HBsAb pre-transplant. In the analytic cohort (n=798), 363 (45.5%) were immune; 50 (13.8%) lost immunity within 1 year. Loss was higher in patients <65 vs ≥65 (17.6% vs 5.9%; RR 2.97, 95% CI 1.38–6.39). Among immune patients, alemtuzumab vs basiliximab showed higher loss (16.4% vs 10.7%; RR 1.53, 95% CI 0.85–2.76). ROC analysis showed moderate prediction (AUC 0.78) with an optimal cutoff ~25 mIU/mL.
Conclusion
About one-third of kidney transplant recipients lacked protective HBV immunity pre-transplant, and loss afterward was common. Higher pre-transplant HBsAb levels predicted more durable protection, suggesting targets above ≥10 mIU/mL. Findings support routine antibody monitoring and improved vaccination as HBV NAT+ donor use increases.
| Characteristic | Alemtuzumab | Basiliximab | Risk Ratio (95% CI) |
| Immune pre-transplant (n) | 220 | 131 | |
| HBsAb loss | 36 / 220 (16.4%) | 14 / 131 (10.7%) | 1.53 (0.85–2.76) |
| <65 years | 36 / 217 (16.6%) | 7 / 20 (35.0%) | |
| ≥65 years | 0 / 3 (0%) | 7 / 111 (6.3%) |