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

Abstract

SummaryBackground and objectives Pre-existing hepatitis B virus (HBV) infection has been associated in inferior renal transplant outcomes. We examined outcomes of HBVϩ renal recipients in a more recent era with availability of oral anti-viral agents.Design, setting, participants, & measurements Using the Organ Procurement Transplant Network/United Network for Organ Sharing database, we selected adult primary kidney recipients transplanted in the United States (2001 to 2007). The cohort was divided into HBVϩ (surface antigen positive, n ϭ 1346) and HBVϪ patients (surface antigen negative; n ϭ 74,335). Five-year graft survival, patient survival, hepatic failure incidence, and associated adjusted risks were compared.Results HBVϩ recipients were more frequently Asian, had a lower body mass index, and glomerulonephritis was more prevalent as the etiology of ESRD. HBVϩ recipients had less pretransplant diabetes and cardiovascular disease, were less likely a living donor recipient, and were less likely to receive steroids at discharge. Five-year patient survival was 85.3% and 85.6% and graft survival was 74.9% and 75.1% for HBVϩ and HBVϪ, respectively. HBV infection was not a risk factor for death or kidney failure, although 5-year cumulative incidence of hepatic failure was higher in HBVϩ recipients (1.3% versus 0.2%; P Ͻ 0.001), and HBVϩ was associated with 5.5-and 5.2-fold increased risk for hepatic failure in living and deceased donors, respectively, compared with HBVϪ. ConclusionsIn a recent era (2001 to 2007), HBV-infected renal recipients were not at higher risk for kidney failure or death; however, they remain at higher risk of liver failure compared with HBVϪ recipients.

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

“…Viral replication and reactivation can develop in HBV (+) Rtx recipients due to immunosuppressive drugs and this can result in many liver pathologies, such as liver cirrhosis and liver failure (1,9,10,23,28,29). Acute viral hepatitis develops more often in patients who are HbsAg(+) (30).…”

“…Increased viral replication due to immunosuppressive treatment after Rtx can lead to viral reactivation, liver damage, liver cirrhosis, liver failure, hepatocellular carcinoma (HCC), superinfections, resistance to antiviral treatment and increased risk for infections (1)(2)(3)(4)(5). Additionally, HBV related glomerulonephritis, de-novo glomerulonephritis, graft disfunction and graft loss can develop (6)(7)(8).…”

“…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).…”

A Single-Center Experience of Overseas Kidney Transplant for Immunologically High-Risk Patients

“…8 In the past, hepatitis infection was a hurdle to successful KT, but, with the availability of more effective antiviral agents, successful viral suppression and better outcomes can be achieved for KT recipients with HBV. 9,10 We also used antiviral agents in HBV-positive recipients after KT to keep their liver function stable during the follow-up. In patients with HCV, because the safety and effectiveness of antiviral treatment after KT have not yet been verified, more careful evaluation is important, and antiviral treatment should be considered before performing the transplant.…”

Complications of Kidney Transplantation: Effects of Over-Immunosuppression

“…In the more recent era, which is distinguished by the availability of oral anti-viral agents, analysis of OPTN/UNOS data has shown equivalent patient and graft survival in HBV(+) versus HBV(-) kidney transplant recipients [87]. The risk of liver failure does, however, continue to be increased in HBV(+) patients [87].…”