Long-Term Outcome of Renal Transplantation in Hepatitis B Surface Antigen-Positive Patients in Cyclosporin Era

Abstract

The impact of hepatitis B virus (HBV) infection on the outcome of renal transplantation (Tx) has been controversial. To determine the indication of renal Tx in patients infected by HBV, we investigated the long-term outcome of renal transplant patients with hepatitis B surface antigen (HBsAg). We analyzed 980 patients, including 18 HBsAg carriers, who underwent renal Tx and were immunosuppressed with cyclosporin in our institute. Fourteen out of 18 patients (77.8%) showed hepatic dysfunction after an average period of 17.8 months (range 1-65) after Tx. Four out of 14 patients (28.5%) with hepatic dysfunction died of liver failure due to fulminant hepatitis with functioning grafts between 15 and 71 months after Tx. The remaining 10 patients with hepatic dysfunction are alive up to the time of last follow-up; however, 5 of them lost their grafts because of rejection between 44 and 92 months after Tx. Their liver function improved after withdrawal of cyclosporin. Only 4 patients did not develop chronic liver disease and have had functioning grafts for between 44 and 147 months. One patient died of subarachnoid hemorrhage 22 months after Tx. HBe antigen, antibody and HCV antibody status were not related to the occurrence of liver dysfunction after Tx. Four HB V-DNA-positive patients showed deteriorated liver function. Three patients with chronic active hepatitis confirmed by the biopsy were treated with interferon. Interferon improved liver function in 2 patients, however, 1 patient died of liver failure despite interferon therapy. Our data suggested that the presence of HBsAg is often associated with chronic liver disease leading to liver failure regardless of HBe and HCV status after Tx. The indication of renal Tx in patients with HBsAg should be determined carefully giving consideration to these results.

Tenofovir Therapy in Hepatitis B Virus-Positive Solid-Organ Transplant Recipients

“…After liver or kidney transplantation, chronic immunosuppression may induce viral replication in asymptomatic carriers of HBsAg or increase viral replication when this is already present at the time of transplantation (23,24). Moreover, chronic HBV can adversely affect patient and graft survival in the long term (25)(26)(27).…”

Hepatitis B in transplantation

“…The question of whether to transplant these patients or not has therefore been a raging controversy for two decades and still remains unresolved. This lack of consensus is certainly not from lack of interest, with numerous reported recent series ( 19–22) as well as older series (summarized in ref. 23).…”

“…HBeAg‐ and HBV‐DNA positive). This expectation is borne out in some series ( 27–29), but there are certainly exceptions ( 19, 21, 30) that suggest that other factors are also important.…”

Clinical Impact of Hepatitis C Virus Infection in the Renal Transplant Recipient

“…Initially, hepatitis B virus (HBV) was the main cause of hepatitis in this population [1]. The screening of blood donors for HBsAg , the isolation of infected patients on separate dialysis machines, the decreased need of blood transfusions due to erythropoietin, and the vaccination of susceptible patients led to the control of this infection in many countries.…”