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Organ Transplantation Techniques and Outcomes / Renal Transplantation Outcomes and Treatments · Journal article
Journal of Evidence-based Medicine · September 7, 2026
Encouraging direction, but not yet definitive.
This retrospective cohort study of 128 HBsAg-positive and 1,145 HBsAg-negative living kidney donors found that HBsAg-positive status was associated with greater serum creatinine rise, higher risk of eGFR <45 mL/min/1.73 m², and substantially increased all-cause mortality after donor nephrectomy. The findings are based on long-term follow-up (median 86–96 months) and multivariable adjustment, but require confirmation in prospective studies.
Retrospective controlled cohort study. Living kidney donors stratified by HBsAg status. The study evaluated long-term kidney and liver function outcomes after donor nephrectomy.. Intervention: HBsAg-positive status (with stratification by HBeAg status, hepatic damage, and anti-HBV therapy receipt). Compared with: HBsAg-negative status. n = 1,273. Not specified in abstract..
HBsAg-positive donors showed greater increase in serum creatinine (12.1 µmol/L vs. 8.4 µmol/L, p < 0.001) compared to HBsAg-negative donors Risk of eGFR <45 mL/min/1.73 m² was higher in HBsAg-positive donors (HR: 2.21, 95% CI: 1.06–4.63, p = 0.035) All-cause mortality was significantly elevated in HBsAg-positive donors (HR: 7.16, 95% CI: 1.71–29.92, p = 0.007)
No information on specific causes of the elevated mortality in HBsAg-positive donors (liver-related vs. kidney-related vs. other). All-cause mortality was significantly elevated in HBsAg-positive donors (HR: 7.16, 95% CI: 1.71–29.92, p = 0.007)
These findings suggest that HBsAg-positive individuals accepted as living kidney donors face substantially elevated risks of progressive kidney dysfunction and mortality after nephrectomy. Clinicians should use these data to counsel prospective HBsAg-positive donors and consider anti-HBV therapy and close monitoring as risk-reduction strategies, though propensity-matched findings require confirmation.
A retrospective cohort study with adequate sample size and multivariable adjustment showing elevated kidney failure risk and mortality in HBsAg-positive donors, but limited by retrospective design, single-centre conduct, and modest effect sizes that require confirmation.
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Quoted from the source exactly as published.
These findings suggest that HBsAg-positive individuals accepted as living kidney donors face substantially elevated risks of progressive kidney dysfunction and mortality after nephrectomy. Clinicians should use these data to counsel prospective HBsAg-positive donors and consider anti-HBV therapy and close monitoring as risk-reduction strategies, though propensity-matched findings require confirmation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
ABSTRACT Background Living donors with hepatitis B virus (HBV) infection are increasingly accepted to alleviate organ shortages. However, after donor nephrectomy, the impact of HBV infection on long‐term kidney function remains unclear in individuals with a solitary functioning kidney. Methods We conducted a retrospective controlled cohort study to evaluate long‐term kidney and liver function, risk of end‐stage kidney disease (ESKD), cancer‐specific mortality, and all‐cause mortality between hepatitis B surface antigen‐positive (HBsAg+) donors and HBsAg– donors. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HR). Results We included 128 HBsAg+ donors and 1145 HBsAg– donors. After a median follow‐up of 86.0 and 96.0 months, HBsAg+ donors demonstrated a greater increase in serum creatinine compared to HBsAg– donors (12.1 µmol/L vs. 8.4 µmol/L, p < 0.001). The rates of ESKD were 0.58 and 2.94 per 1000 person‐years, and the rates of estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m 2 were 3.65 and 9.99 per 1000 person‐years in the HBsAg– and HBsAg+ donors. Further, HBsAg+ donors had a higher risk of eGFR < 45 mL/min/1.73 m 2 (HR: 2.21, 95% confidence interval [CI]: 1.06–4.63, p = 0.035). The mortality was 1.4 and 6.85 per 1000 person‐years in HBsAg– and HBsAg+ donors, respectively. After full adjustment, HBsAg+ status was an independent risk factor of death (HR: 7.16, 95% CI: 1.71–29.92, p = 0.007). Sensitivity analyses after propensity score matching reported numerically higher incidence of ESKD and marginally higher incidence of eGFR < 45 mL/min/1.73 m 2. Stratified analyses revealed that hepatitis B e antigen‐positive status ( p < 0.001) and hepatic damage ( p = 0.005) may be associated with higher incidence of ESKD, while receiving anti‐HBV therapy may reduce the risk ( p = 0.004). Conclusions HBsAg+ individuals may have a higher absolute long‐term kidney failure risk and mortality after living donor nephrectomy. These findings might improve donation‐attributable risk estimates and add new information to the utilization and management of live donors with HBV infection.
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