Clinical outcome of renal transplantation in patients with positive pre‐transplant hepatitis B surface antigen

Abstract

The clinical outcomes of 2,054 renal recipients were examined retrospectively based on pre-transplant hepatitis B surface antigen (HBsAg) status to investigate the efficacy of lamivudine treatment in HBsAg positive recipients. Pre-transplant HBsAg positivity was documented in 66 recipients. The 10-year patient and graft survival rates in Ag positive group were significantly lower than those of Ag negative group (64.4/36.6% vs. 88.2/70.5%, respectively, P < 0.0001). Since 1997, lamivudine was used when hepatitis B virus polymerase chain reaction (HBV PCR) was positive or when the level of post-transplant viral load rose. Lamivudine given to 27 recipients markedly improved both 10-year patient and graft survivals compared to Ag positive renal recipients who did not take lamivudine (85.3/59.2% vs. 49.9/22.7%, respectively, P < 0.0001). Overall, 13 viral breakthroughs among 24 lamivudine-responsive patients were observed. The cumulative incidence of viral breakthrough at 60 months was 53.3%. Adefovir rescue in three viral breakthroughs patients induces virological response and restoration of liver function. In 10 patients who did not changed to adefovir, 6 patients are alive with elevated liver enzymes. In conclusion, in the era of lamivudine and adefovir, renal transplantation in HBsAg positive end-stage renal disease patients should not be abandoned.

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

“…Chan et al (14) described 12 HBsAgϩ recipients who received lamivudine preemptively, i.e., when a increase in HBV DNA levels with or without elevation in aminotransferase levels were detected, had similar renal allograft recipient survival compared with HBSAgϪ controls in contrast to their HBVinfected recipients transplanted before lamivudine was available. Ahn et al (17) included transplants performed between 1979 and 2004 and found 10-year patient, graft, and death-censored graft survival were inferior in HBsAgϩve (n ϭ 66) compared with HBsAgϪve (n ϭ 1988) recipients. However, in 27 HBsAgϩve recipients who received lamivudine, 10-year patient overall and kidney death censored survivals were comparable with HBsAgϪve recipients.…”

Comparison of Clinical Outcomes in Hepatitis B Virus–Positive and –Negative Renal Transplant Recipients

“…However, a study have revealed that 5 years patient and graft survival rates were similar between HbsAg(+) and HbsAg(-) patients (1). Ahn et al revealed that, 27 HbsAg(+) recipients' (who were treated with lamivudine) graft and patients survival rates were similar to the HbsAg(-) patients (16).…”

“…Some studies revealed that 5 years patient survival rate was worse in HbsAg(+) patients, while another study revealed that HbsAg positivity had no impact on patient survival rate (12)(13)(14)(15)(16). However, a study have revealed that 5 years patient and graft survival rates were similar between HbsAg(+) and HbsAg(-) patients (1).…”

“…Also, the effectivness of antiviral treatment, interferon or nucleoside analogues in HBV(+) patients have been demonstrated by some authors (16)(17)(18)(19)(20)(21)(22).…”

“…Many studies have been performed in order to determine the effects of HBV infection on graft or survival rates and liver complications after Rtx to HBV(+) patients (1,(9)(10)(11)(12)(13)(14)(15)(16)(17). Also, the effectivness of antiviral treatment, interferon or nucleoside analogues in HBV(+) patients have been demonstrated by some authors (16)(17)(18)(19)(20)(21)(22).…”