Pretransplant Hepatitis B viral infection increases risk of death after kidney transplantation

Jeonghwan Lee, Jang Hee Cho, Jong Soo Lee, Dong Won Ahn, Chan Duck Kim, Curie Ahn, In Mok Jung, Duck Jong Han, Chun Soo Lim, Yon Su Kim, Young Hoon Kim, Jung Pyo Lee

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16 Scopus citations

Abstract

Clinical outcomes in kidney transplant recipients (KTRs) with hepatitis B virus (HBV) have not been thoroughly evaluated. Here, we investigated recent posttransplant clinical outcomes of KTRs with HBV and compared them with KTRs with hepatitis C virus (HCV) and seronegative KTRs. Of 3855 KTRs from April 1999 to December 2011, we enrolled 3482 KTRs who had viral hepatitis serology data; the patients were followed up for 89.1±54.1 months. The numbers of recipients with HBV and HCV were 160 (4.6%) and 55 (1.6%), respectively. We analyzed the clinical outcomes, including overall mortality and graft failure, among patients who had undergone kidney transplantation. Patients with HBV showed poorer survival (P=0.019; adjusted hazard ratio [HR]=2.370; 95% confidence interval [CI]: 1.155-4.865) than KTRs without HBV. However, the graft survival of patients with chronic hepatitis B did not differ from that of patients without HBV. Hepatic complications were the primary causes of mortality of KTRs with HBV. Mortality significantly correlated with a higher grade of inflammation (P=0.002) and with the use of lamivudine or adefovir antiviral treatment (P=0.016). HBV-positive KTRs treated with the new-generation antiviral agent entecavir showed improved patient survival compared with KTRs receiving lamivudine (log-rank P=0.050). HCV did not affect patient survival; however, it increased the incidence of graft failure (P=0.010; adjusted HR=2.899; 95% CI: 1.289-6.519). KTRs with HCV had an increased incidence of acute rejection (log-rank P=0.005, crude HR=2.144; 95% CI: 1.341-3.426; P=0.001). KTRs with chronic hepatitis B may exhibit poor survival due to post-transplantation hepatic complications. Pretransplant histological liver evaluations and adequate antiviral management with potent nucleoside/nucleotide analogues are needed to improve the survival of KTRs with chronic hepatitis B even when liver function is within the normal range.

Original languageEnglish
Article numbere3671
JournalMedicine (United States)
Volume95
Issue number21
DOIs
StatePublished - 1 May 2016

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