Comparison of Clinical Outcomes in Hepatitis B Virus-Positive Renal Transplant Recipients with or without Pre-Transplant Antiviral Treatment

Abstract

Background: Liver disease related to pre-existing hepatitis B virus (HBV) is a major cause of morbidity and mortality in HBV-positive renal transplant recipients (RTRs). The aim of this study was to evaluate the impact of pre-transplant antiviral therapy on clinical outcomes in HBV-positive RTRs. Methods: Sixty-nine HBV-positive RTRs were included for 25 years. We divided the patients with (Pre-treatment group, N=25) and without anti-viral treatment (historical control group, N=44) according to the time of kidney transplantation; before and after 2000, which is when lamivudine had become available commonly in clinical practice. We compared these two groups in terms of graft and patient survival, and risk factor analysis was performed to evaluate the importance of pre-transplant antiviral therapy in patient and graft survival. Results: The pre-treatment group had better graft (82% vs. 34% at 10 years, P=0.003) and patient (90% vs. 57% at 10 years, P=0.013) survival rate than the historic control group. There was no liver-related mortality in the pre-treatment group. In contrast, 81% of historic control group died of liver-related mortality, and the leading cause of death was fulminant hepatitis (75%) during the 10-year follow-up period. In addition, prophylactic and preemptive antiviral therapy showed similar clinical outcomes in terms of graft (P=0.266) and patient survival (P=0.450). Pre-transplant antiviral therapy was independent factor for improved patient survival (P=0.005). Conclusion: Pre-transplant antiviral treatment is essential to improve graft and patient survival in HBV-positive RTRs.