Abstract
Few reports detail the actual outcome of Hepatitis B Surface Antigen-positive patients after kidney transplant. HBsAg-positive patients who underwent kidney transplant between January, 1999, and December, 2018, were reviewed retrospectively. Outcomes including hepatitis B reactivation rate, risk factors for reactivation, and patient and graft survival rates were analyzed. Seventy-seven patients were enrolled (47.1 ± 11.5 years old). Patients received ABO-incompatible (n = 5), crossmatch positive transplant (n = 2), and re-transplant (n = 4). Forty-six patients received prophylactic; 19, medication at least 3 months before the transplant; and 12, did not receive medication. Seventeen out of 76 patients developed reactivation post-transplant. 52.9% of HBV reactivation was accompanied by hepatitis. Inappropriate, other than lifelong prophylactic, antiviral agents (HR = 7.34, 95% CI 1.51–35.69, P = 0.01) and high hepatitis DNA (≥ 1000 IU/ml) pre-transplant (HR = 4.39, 95% CI 1.08–17.81, P = 0.04) increased reactivation risk. There was no significant difference in patient and graft survival between antigen positive patients who received antiviral agent and propensity score matched negative patients. HBsAg positivity in kidney transplant recipients is associated with substantial HBV reactivation rate. Lifelong antiviral therapy is mandatory, and patients with high preop HBV titer should be monitored closely for HBV reactivation.
Highlights
Abbreviations anti-thymocyte globulin (ATG) Anti-thymocyte globulin CI Confidence interval Hepatitis B Surface Antigen (HBsAg) Hepatitis B surface antigen hepatitis B virus (HBV) Hepatitis B virus HR Hazard ratio
The introduction of antiviral agents improved patient and graft survival, the risk of liver failure is still higher in HBV infected patients than uninfected patients[3]
Male Age Cause of ESRD Glomerulonephritis Diabetes Hypertension IgA Polycystic kidney disease Other Unknown Living donor Re-transplantation ABOi HLA mismatches Positive crossmatch Abnormal ALT levels before treatment HBV status of recipients HBsAg positive Unknown baseline HBV DNA HBV DNA < 1000 IU/ml HBV DNV ≥ 1000 IU/ml HBV status of donors HBsAg positive Anti-HBc positive/HBsAg negative Immunosuppressants ATG as induction Basiliximab as induction Rituximab as desensitization TAC + MMF + prednisolone as maintenance CsA + MMF + prednisolone as maintenance Other as maintenance
Summary
Abbreviations ATG Anti-thymocyte globulin CI Confidence interval HBsAg Hepatitis B surface antigen HBV Hepatitis B virus HR Hazard ratio. Before introduction of antiviral agents, infection with hepatitis B virus (HBV) is known to be associated with high mortality and morbidity in kidney transplant recipients[1,2]. The introduction of antiviral agents improved patient and graft survival, the risk of liver failure is still higher in HBV infected patients than uninfected patients[3]. The current guideline recommends preemptive or prophylactic treatment for anti-HBc positive patients and prophylactic antiviral for Hepatitis B Surface Antigen (HBsAg) positive patients when they need immunosuppressive therapy for transplant[12]. There are few reports about outcomes including HBV reactivation in HBsAg-positive patients in kidney transplant setting because of its rare incidence. The objective of this study is to investigate real-world outcomes including HBV reactivation after kidney transplantation in HBsAg-positive patients. Male Age (years) Cause of ESRD Glomerulonephritis Diabetes Hypertension IgA Polycystic kidney disease Other Unknown Living donor Re-transplantation ABOi HLA mismatches Positive crossmatch Abnormal ALT levels before treatment HBV status of recipients HBsAg positive Unknown baseline HBV DNA HBV DNA < 1000 IU/ml HBV DNV ≥ 1000 IU/ml HBV status of donors HBsAg positive Anti-HBc positive/HBsAg negative Immunosuppressants ATG as induction Basiliximab as induction Rituximab as desensitization TAC + MMF + prednisolone as maintenance CsA + MMF + prednisolone as maintenance Other as maintenance
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