Ann Surg Treat Res.  2014 May;86(5):256-263. 10.4174/astr.2014.86.5.256.

High pretransplant HBV level predicts HBV reactivation after kidney transplantation in HBV infected recipients

• Kim JM
• Park H
• Jang HR
• Park JB
• Kwon CH
• Huh W
• Lee JH
• Kim SJ
• Joh JW

• KMID: 1889663
• DOI: http://doi.org/10.4174/astr.2014.86.5.256

Abstract

PURPOSE
HBsAg-positive kidney recipients are at increased risk for mortality and graft failure. The aims of this study were to identify the outcomes of HBsAg-positive recipients who received preemptive antiviral agents after successful kidney transplantation and to analyze risk factors for HBV reactivation.
METHODS
We retrospectively reviewed the medical records of 944 patients performed kidney transplantation between 1999 and 2010.
RESULTS
HBsAg-negative recipients were 902 patients and HBsAg-positive recipients, 42. Among HBsAg-positive recipients, HBV reactivation was detected in 7 patients and well controlled by switch or combination therapy. Graft failure developed in only one patient due to chronic rejection regardless of HBV reactivation but no deaths occurred. All patients were alive at the end of follow-up and none developed end-stage liver disease or hepatocellular carcinoma. There was statistically significant difference in graft survival between HBsAg-positive recipients and HBsAg-negative. Multivariate analysis identified increased HBV DNA levels (>5 x 10(4) IU/mL) in the HBsAg-positive kidney transplant recipients as a risk factor for HBV reactivation (P = 0.007).
CONCLUSION
Effective viral suppression with antiviral agents in HBsAg-positive renal transplant recipients improves patient outcome and allograft survival. Antiviral therapy may be especially beneficial in patients with high HBV DNA levels prior to transplantation.

Keyword

Kidney transplantation; Hepatitis B virus; YMDD mutation; HBV reactivation

MeSH Terms

Allografts
Antiviral Agents
Carcinoma, Hepatocellular
DNA
Follow-Up Studies
Graft Survival
Hepatitis B virus
Humans
Kidney
Kidney Transplantation*
Liver Diseases
Medical Records
Mortality
Multivariate Analysis
Retrospective Studies
Risk Factors
Transplantation
Transplants
Antiviral Agents
DNA

Figure

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  Fig. 1 Serum creatinine levels after transplantation. The serum creatinine in HBsAg-positive recipients was higher than in HBsAg-negative at 2 weeks (P = 0.010) because the proportion of deceased donor kidney transplantation was higher than that in living donor kidney transplantation in HBsAg-positive recipients. We found no significant difference in the median serum creatinine levels at 1-, 3-, 6-, 9-, or 12-month posttransplant between the two groups (P = not significant).

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  Fig. 2 Death-censored graft survival between HBsAg-positive recipients and HBsAg-negative recipients.

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  Fig. 3 Schematization of antiviral prophylaxis.

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  Fig. 4 Receiver operating characteristics curve showed that the cutoff value of HBV DNA was 5 × 104 IU/mL (R2 = 77.1% and P = 0.025, respectively).

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  Fig. 5 Difference of HBV DNA levels before transplantation between patients with HBV reactivation and without HBV reactivation.

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