Hepatitis B Reactivation in HBsAg Negative Renal Transplant Patients with Evidence of Previous HBV Infection: A Not Neglectable Occurrence

Abstract

Hepatitis B virus (HBV) infection is frequent among patients with chronic kidney disease (CKD). HBV reactivation after kidney transplant (KT) is more common in patients with HBsAg+; however, it can also occur in previously infected individuals, particularly those with HBsAg negative and total antiHBc positive (HBsAg-/antiHBcT+). However, reactivation in this population has scarce and conflicting data. This study aimed to assess the reactivation risk in KT recipients with previous HBV infection (antiHBcT+). A retrospective cohort study was conducted, including patients with KT between January 1993 and December 2012 with HBsAg+ (G1) and with previous HBV infection (antiHBcT+) (G2). A total of 10,493 transplants were performed in this period. A total of 203 patients were included (122 HBsAg+ and 81 HBsAg-/anti-HBcT+). The reactivation of infection occurred in 24.6% (30/38) patients and 9.8% (8/30) in G1 and G2, respectively. Detectable HCV RNA, indicating HCV coinfection, was the only variable related to reactivation in patients with antiHBcT+, protecting its occurrence (p: 0.001). In conclusion, reactivation of HBV infection in KT recipients with the previous infection, occurring in approximately 10% of cases, should be considered. Complete HBV serology is recommended before KT, and patients with HBsAg-/anti-HBcT+ should be monitored after the procedure. Prophylaxis may be indicated when adequate follow-up is not feasible. HCV coinfection appears to be a protective factor for reactivation.