Hepatitis Transmission Risk in Kidney Transplantation (the HINT study)

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Abstract
Interpreting hepatitis serology and virus transmission risk in transplantation can be challenging. Decisions must balance opportunity to transplant against potential infection transmission. We aimed to survey understanding among the Australian and New Zealand medical transplant workforce of hepatitis risk in kidney donors and recipients. An anonymous, self-completed, cross-sectional survey was distributed via electronic mailing lists to Australian and New Zealand clinicians involved in kidney transplantation (2014-2015). We compared interpretation of clinical scenarios with paired donor and recipient hepatitis B and C (HBV, HBC) serology to recommendations in clinical practice guidelines. We used logistic regression modelling to investigate characteristics associated with decisions on transplant suitability in scenarios with poor (<50%) guideline concordance (odds ratios, OR). 110 respondents had representative workforce demographics: most were male (63%) nephrologists (74%) aged 40-49. While donor and recipient hepatitis status was largely well understood, transplant suitability responses varied among respondents. For an HBV surface antigen positive donor and vaccinated recipient, 44% suggested this was unsuitable for transplant (guideline concordant) but 35% suggested this was suitable with prophylaxis (guideline divergent). In 4 scenarios with transplant suitability guideline concordance <50%, acute transplant care involvement predicted guideline concordant responses (OR 1.69, p=0.04). Guideline concordant responses were chosen less by hepatologists, intensive care doctors (OR 0.23, 0.35 respectively, p=0.01), and New Zealanders (guideline concordant responses OR 0.17, p<0.01; alternative responses OR 4.31, p<0.01). Despite broadly consistent interpretations of hepatitis serology, transplant suitability decisions varied, and often diverged from guidelines. Improved decision support may reduce clinician variability.

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