Natural History of Hepatitis B Virus Infection in Renal Transplant Recipients-A Fifteen-Year Follow-Up

Abstract

Hepatitis B virus (HBV) markers were measured in 83 immunosuppressed renal transplant patients who were followed for periods of 2 to 15 years. Sixty-nine patients were negative for HBsAg before transplantation, of whom 14 were positive for anti-HBs. The remaining 14 patients were HBsAg positive prior to transplantation. Eighteen patients were identified as being HBsAg positive during the follow-up period. Four patients acquired primary type B hepatitis; one died of submassive hepatic necrosis and the remaining three became chronic HBV carriers with positive HBeAg, DNA polymerase, and HBV DNA. Several patterns of HBV expression were observed in HBsAg-positive patients. Four patients were HBsAg, HBeAg, DNA polymerase, and HBV DNA positive prior to transplantation, and these markers persisted. Reactivation of HBV replication occurred in eight patients, seven of whom were HBsAg positive and HBeAg and anti-HBe negative originally; one patient was anti-HBc positive. A single patient was HBsAg and anti-HBe positive and remained so for 22 months. The remaining previously HBsAg-positive patient is currently HBsAg negative. These serological data suggest that reactivation of HBV replication or continued hepatitis B virion replication occurs as commonly or more commonly than de nouo infection in renal transplant recipients. The presence of HBeAg in serum predisposes to long-term Dane particle expression in immunosuppressed patients, whereas anti-HBe-positive carriers may not always be susceptible to reactivation of HBV replication despite immunosuppression.Several viral infections are potentiated in immunocompromised hosts. Cytomegalovirus, herpes simplex, varicella-zoster, and Epstein Barr virus infection occur with increased frequency in immunosuppressed renal transplant recipients (1). Patients with chronic renal failure on maintainance hemodialysis and renal transplant recipients are particularly liable to chronic hepatitis B virus (HBV) infection (2, 3). Viral replication is favored in azotemic hemodialysis patients, and they are frequently hepatitis B e antigen (HBeAg) positive and HBV DNA polymerase positive (4).Reactivation of type B hepatitis may follow treatment with immunosuppressive drugs and chemotherapy. Reappearance of HBsAg in serum of HBsAg-negative

Novel Double-Antigen Sandwich Immunoassay for Human Hepatitis B Core Antibody

“…HBV reactivation has been reported during cancer chemotherapy, during HIV infection, and after kidney and bone marrow transplantation (5,7,20,22). There are at least 2 reported cases of HBV reactivation with liver inflammation after rituximab administration, and one patient died When a patient is diagnosed to be reactive for "anti-HBc alone," several explanations might apply to this phenomenon.…”

Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

“…In patients with past infection (antiHBs and anti-HBc positive), HBV reactivation has been reported during chemotherapy, HIV infection, and after kidney and bone marrow transplantation [14][15][16][17] . In the present study, HBV reactivation with reappearance of HBsAg was observed in one "anti-HBc alone" patient after treatment with rituximab (humanized monoclonal antibody to CD 20) and chemotherapy for non-Hodgkin lymphoma.…”

Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure

“…Forty-one percent of breast cancer patients positive for HBsAg have been reported to experience HBVr [18] . HBVr has been reported in patients receiving immunosuppression for inflammatory bowel disease [37,38] , rheumatological diseases (rheumatoid arthritis, ankylosing spondylitis) [39][40][41][42][43][44] , dermatological disorders (psoriasis) [45] , autoimmune disorders [46,47] and in those following solid organ transplantation (e.g., renal and liver) [48][49][50][51][52] .…”