Hepatitis B in renal transplant patients

Abstract

Hepatitis B virus (HBV) poses a significant challenge for both dialysis patients and kidney transplant recipients despite its decreasing rates, especially in developed countries. The best preventive method is vaccination. Patients with chronic renal disease should ideally be vaccinated prior to dialysis, otherwise, reinforced vaccination practices and close antibody titer monitoring should be applied while on dialysis. HBV infected dialysis patients who are renal transplant candidates must be thoroughly examined by HBV-DNA, and liver enzyme testing and by liver biopsy. When needed, one must consider treating patients with tenofovir or entecavir rather than lamivudine. Depending on the cirrhosis stage, dialysis patients are eligible transplant recipients for either a combined kidney-liver procedure in the case of decompensated cirrhosis or a lone kidney transplantation since even compensated cirrhosis after sustained viral responders is no longer considered an absolute contraindication. Nucleoside analogues have led to improved transplantation outcomes with both long-term patient and graft survival rates nearing those of HBsAg(-) recipients. Moreover, in the cases of immunized HBsAg(-) potential recipients with concurrent prophylaxis, we are enabled today to safely use renal grafts from both HBsAg(+) and HBsAg(-)/anti-HBc(+) donors. In so doing, we avoid unnecessary organ discarding. Universal prophylaxis with entecavir is recommended in HBV kidney recipients and should start perioperatively. One of the most important issues in HBV(+) kidney transplantation is the duration of antiviral prophylaxis. In the absence of robust data, it seems that prophylactic treatment may be discontinued in selected stable, low-risk recipients during maintenance immunosuppression and should be reintroduced when the immune status is altered. All immunosuppressive agents in kidney transplantation can be used in HBV(+) recipients. Immunosuppression is intimately associated with increased viral replication; thus it is important to minimize the total immunosuppression burden long term.

Safety and efficacy of direct-acting antivirals for chronic hepatitis C in patients with chronic kidney disease

“…The prevalence of HCV in hemodialysis patients is notably higher than the general population, varying between 5 and 10% in Europe and in the USA [39]. In the Sub-Carpathian and South-Eastern regions of Romania, HCV seroprevalence was reported to be as high as 39.26% in hemodialyzed patients [40]. The development of DAAs has enlarged therapeutic options in patients with severe CKD and replacement of kidney function.…”

Hepatitis C in Hemodialysis Units: diagnosis and therapeutic approach

“…28 Another point of concern is the phenomenon of intermittent viremia, which is not only epidemiological, but also an inconvenience in the control of nosocomial transmission, since the results can be misinterpreted, classifying a patient with active infection as non-virememic. 18,20,29,30 The use of molecular tests with low detection levels should always be recommended.…”

Treatment and management options for the hepatitis C virus infected kidney transplant candidate

“…It is estimated that approximately 3 million people in the United States have chronic HCV infection with estimates approaching 170 million worldwide, although these numbers likely underestimate the true prevalence in the context that many people in established at‐risk populations have not been screened and remain undiagnosed. The prevalence of HCV infection among CKD and ESRD patients exceeds that of the general population with reports demonstrating infection in 8% to 44% of dialysis patients in the United States and other developed countries and even higher in parts of Latin America and the Middle East.…”