Significant rate of hepatitis B reactivation following kidney transplantation in patients with resolved infection
Section snippets
Background
Hepatitis B virus (HBV) infection entails a significant rate of morbidity and mortality in kidney transplant recipients (KTRs).1, 2 After successful renal transplantation, the rate of spontaneous hepatitis B surface antigen (HBsAg) clearance is decreased compared to the general population.3 Indeed, immunosuppression affects the T- and B-cell functions that are essential in the control of HBV infection, and steroids stimulate HBV replication by a direct effect on a glucocorticoid responsive
Objectives
The aims of our study were to evaluate the incidence of post-transplant HBV reactivation in patients who had previously cleared HBsAg and to identify potential risk factors for reactivation.
Study population
Retrospective cohort study included patients with previously resolved hepatitis B infection transplanted with a kidney at the Cliniques Universitaires Saint-Luc (Brussels, Belgium) between January 1995 and December 2007. Diagnostic criteria for resolved HBV infection at transplantation were: HBsAg negative, anti-HBc positive, anti-HBs positive or negative, and normal liver enzymes. HBsAg reversion was defined as the reappearance of HBsAg during follow-up. HBV reactivation was defined as HBsAg
Patient characteristics
The files of 764 KTRs were reviewed. Ninety-three patients (12%) were included (Table 1). All patients received 20 mg of prednisolone daily following transplantation, rapidly tapered to 5 mg/day at week 6.
Prophylaxis against cytomegalovirus was administered for a period of 3 months in seronegative patient receiving a seropositive graft. Patients did not receive prophylaxis against Pneumocystis.
Patient and graft survival
Patients were followed after transplantation for a median time of 73 [44–114] months. Five and 10-year
Discussion
Reactivation of HBV in patients with resolved infection could result from persisting occult HBV in the serum or the liver.16, 17, 18, 19, 20 In our 5 patients with HBV reactivation and available pre-transplant serum, HBV DNA was not detectable before transplantation in the serum of any of them. Reinfection with a different HBV strain seems improbable because neither patient received blood transfusion, underwent hemodialysis, or had other risk factors for hepatitis B in the post-transplant
Funding
None.
Competing interests
None declared.
Ethical approval
Ethical approval was provided by the Commission of Biomedical Ethics of the Université Catholique de Louvain in Brussels, Belgium.
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