A large percentage of patients with end stage renal disease are known to be Hepatitis B virus (HBV) positive. A 2015 consensus guideline on use of HBV (+) donors provided guidance on prevention of HBV transmission. There has been minimal data identifying the risks and prevention strategies for reactivation of latent HBV post kidney transplantation. Prior to 2014, our institution did not have a well-developed protocol for managing patients who received hepatitis B core antibody (+) (HBcAb (+)) kidneys or those who were HBcAb + prior to kidney transplant. Our study describes how we implemented a risk management strategy for prevention of HBV reactivation post kidney transplantation. Methods: The new protocol stratified patients into high, medium and low risk based on donor and recipient HBV serologies. Reports were generated to identify patients who received HBcAb (+) donors or who were HBcAb (+). Records were reviewed to determine if patients were on appropriate antiviral therapy. Additionally, data regarding the date of last follow-up, date and results of HBV serologies and use of lamivudine (LAM), entecavir and tenofovir were collected. Low and moderate risk patients who stopped LAM or who were never on LAM were contacted, informed and tested. Based on lab results, patients were counseled to resume LAM, start LAM or begin twice yearly testing. Results: A total of 75 patients were identified who were never on LAM, 4 received HBcAb (+) kidneys and 70 were identified as HBcAb (+). Of the 4 who received HBcAb (+) donors, 3 had follow-up labs documenting no change in serology and 1 died of an unknown cause. Of the 70 identified as HBcAb (+), 46 had follow-up labs and 4 were started on LAM. On follow-up, 2 patients changed from HBcAb (+) to HBcAb (-). A total of 13 patients were previous prescribed LAM but discontinued therapy, 9 received a HBcAb (+) kidney and 4 were identified as HBcAb (+). Of the 13 patients who stopped LAM, 9 had follow-up labs which indicated no change in their previously documented serologies. Conclusion: More than half of our pts patients received the prescribed follow-up labs after implementation of this protocol in the last year. We will continue our efforts to get everyone tested as appropriate. We did not identify any cases of HBV reactivation or seroconversion.

CITATION INFORMATION: Cote M, Pavlakis M, Ethridge J, Currier C, Curry M, Khankin E, Cardarelli F, Richards K, Rogers C. Implementation of a Risk Stratified Approach for Prevention of Hepatitis B Reactivation Post Kidney Transplant. Am J Transplant. 2016;16 (suppl 3).

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