PD22-12 COST-EFFECTIVENESS OF KIDNEY TRANSPLANTATION IN HEPATITIS-B INFECTED PATIENT WITH END-STAGE RENAL DISEASE

Abstract

INTRODUCTION AND OBJECTIVE: Is it worthy to undergo kidney transplantation in hepatitis B-infected (HBV+) end-stage renal disease (ESRD) patients ? Do the health benefits outweigh risks? We conducted this study to measure clinical outcomes of kidney transplantation in HBV+ ESRD patients. METHODS: We recruited 138,338 patients with ESRD from Taiwan national health insurance research database (NHIRD) from 2000 to 2013. There were 4895 ESRD patients infected with hepatitis B virus(HBV), with exclusion of other concurrent viral hepatitis. The study groups were divided into kidney transplant (KT+) 172 patients, and non-KT (KT-) 4704 patients. Propensity-score matching comparison were performed for survival and risk outcome of kidney transplantation. RESULTS: There were similar characteristics among these 2 groups, except more diabetes mellitus patients in non-kidney transplant group and more high economic patients in kidney transplant group. For the ESRD patients outcome analysis, multivariate analysis of characteristics was performed. The age (HR=5.52, 95% CI:1.6-19.05, p=0.007) and coronary artery disease (HR=2.03, 95%CI:1.02-4.01,p=0.043) were correlated with survival after KT respectively. The survival benefits were more evident one year after KT.ESRD patients with HBV had equal risk of death on day 462 after kidney transplant and had equal survival after around 1649 days after kidney transplant. CONCLUSIONS: HBV-infected ESRD patient had higher risk of disease flare-up and even death risk after KT under the potent immunosuppressants without definite eradicating treatment currently. However, there was similar risk and survival curve crossing point which was observed lightly later than the well-accepted kidney transplant curve. As a result, it is not only applicable but also beneficial for ESRD patients with HBV to undergo kidney transplantation.Source of Funding: 1. Taichung Veteran General Hospital