Impact of pre-existing hepatitis B infection on the outcomes of kidney transplant recipients in the United States.
ABSTRACT Pre-existing hepatitis B virus (HBV) infection has been associated in inferior renal transplant outcomes. We examined outcomes of HBV+ renal recipients in a more recent era with availability of oral anti-viral agents.
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 HBV+ (surface antigen positive, n = 1346) and HBV- patients (surface antigen negative; n = 74,335). Five-year graft survival, patient survival, hepatic failure incidence, and associated adjusted risks were compared.
HBV+ recipients were more frequently Asian, had a lower body mass index, and glomerulonephritis was more prevalent as the etiology of ESRD. HBV+ 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 HBV+ and HBV-, respectively. HBV infection was not a risk factor for death or kidney failure, although 5-year cumulative incidence of hepatic failure was higher in HBV+ recipients (1.3% versus 0.2%; P < 0.001), and HBV+ was associated with 5.5- and 5.2-fold increased risk for hepatic failure in living and deceased donors, respectively, compared with HBV-.
In 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 HBV- recipients.
Article: Hepatitis B virus and hepatitis B-related viral infection in renal transplant recipients. A prospective study of 90 patients.[show abstract] [hide abstract]
ABSTRACT: Hepatitis B virus (HBV) infection may induce severe hepatitis and affect long-term survival of kidney transplant recipients. Persistent viral infection has been shown to occur despite the absence of usual serologic markers. The liver and serum HBV deoxyribonucleic acid (DNA) status of 90 patients were studied prospectively; recently transplanted patients, both hepatitis B virus surface antigen (HBsAg)-positive and negative, with and without liver disease, were investigated with HBV serology, serum HBV DNA, and liver histology. Thirty-four patients had detectable HBsAg, and 21 had viral multiplication at the time of transplantation. Serial HBV DNA determinations performed in 57 of 90 patients disclosed (a) reactivation of HBV replication in 11 of 12 HBsAg-positive patients, (b) increase of viral replication when positive on the initial sample in 6 of 11 patients, and (c) development of HBV replication in 7 of 35 of the HBsAg-negative patients. Moreover, liver HBV DNA studies showed a statistical correlation between the presence of integrated liver HBV DNA and chronic hepatitis in HBsAg-negative patients. This study demonstrates prospectively the significant association of HBsAg-positive as well as HBsAg-negative HBV infection with chronic hepatitis and suggests that immunosuppressive therapy may enhance the viral replication in both HBsAg-positive and negative subjects.Gastroenterology 02/1988; 94(1):151-6. · 11.68 Impact Factor