Outcomes and risk factors for hepatitis B virus (<scp>HBV</scp>) reactivation after kidney transplantation in occult <scp>HBV</scp> carriers

Chen, G.-D.; Gu, Jing; Qiu, Jian; Chen, L.-Z.

doi:10.1111/tid.12065

Cited by 49 publications

(54 citation statements)

References 16 publications

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“…Regarding the outcome of OBI, the opposite is true for KTxR, where a reactivation of an HBV infection in HBsAg‐negative individuals under immunosuppression is of high relevance and may lead to a possibly fatal fulminant hepatitis. Data of OBI prevalence in KTxR are scarce and mostly focus on HBV reactivation rates in HBsAg‐negative patients after transplantation which have been reported to be between 0.9% and 6.5% . In a Korean study, OBI was detected in 2.3% (5/217) patients before KTx, with no HBV reactivation documented in the 36‐month follow‐up period after KTx .…”

Section: Discussionmentioning

confidence: 99%

“…Data of OBI prevalence in KTxR are scarce and mostly focus on HBV reactivation rates in HBsAgnegative patients after transplantation which have been reported to be between 0.9% and 6.5%. [26][27][28] In a Korean study, OBI was detected Additional testing for HBV DNA in PBMCs has been suggested to uncover occult infections not detected by serologic methods or virus determination in serum, avoiding the potential risk of a liver biopsy. [12][13][14] Though the existence of HBV in extrahepatic tissue had been debated controversially, there is evidence that HBV can infect and replicate in PBMCs.…”

Section: Serum Only Pbmcs Only Serum + Pbmcsmentioning

confidence: 99%

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Low prevalence of occult hepatitis B virus infection in chronic haemodialysis and kidney transplant patients

Muche

Berg

Rimpler

et al. 2018

Liver International

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Section: Discussionmentioning

confidence: 99%

Section: Serum Only Pbmcs Only Serum + Pbmcsmentioning

confidence: 99%

Low prevalence of occult hepatitis B virus infection in chronic haemodialysis and kidney transplant patients

Muche

Berg

Rimpler

et al. 2018

Liver International

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“…3,47–50 Reactivation of HBV replication with reappearance of HBsAg has also been reported in HBsAg-negative–anti-HBc-positive recipients of kidney transplants, although the incidence is low (0.9–5%); 51,52 however, reverse seroconversion can occur as late as 15 years after transplantation, and in some instances, correlate with a decrease in the anti-HBs titre. 51 Similar findings have been reported in heart and lung transplant recipients.…”

Section: Solid Organ Transplantationmentioning

confidence: 95%

Management of patients with hepatitis B who require immunosuppressive therapy

Hwang

Lok

2013

Nat Rev Gastroenterol Hepatol

218

177

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Patients with chronic HBV infection are at risk of reactivation of HBV should they require immunosuppressive therapies for a variety of clinical settings, including chemotherapy for patients with cancer, immunosuppression for solid organ and stem cell transplant recipients, and use of anti-CD20 antibodies, TNF inhibitors, or corticosteroids in patients with oncological, gastrointestinal, rheumatological or dermatological conditions. The key to preventing HBV reactivation is the identification of patients with HBV infection prior to immunosuppressive therapy, initiation of prophylactic antiviral therapy in patients at moderate or high risk of HBV reactivation, and close monitoring of other patients so that antiviral therapy can be initiated at the first sign of HBV reactivation. Unfortunately, many patients infected with HBV are unaware of their infection or risk factors, and physicians often do not have sufficient time to systematically assess patients for risk factors for HBV prior to starting immunosuppressive therapy. In this article, we review the incidence, risk factors and outcomes of HBV reactivation, and the efficacy of antiviral therapy in preventing its occurrence. We also propose an algorithm for managing patients with HBV infection who require immunosuppressive therapy.

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“…Although the prevalence of HBV in patients with ESRD undergoing dialysis has decreased significantly during the past few decades [13], it remains a distinct clinical problem due to the immunosuppressive nature of renal disease that often leads to a chronic viral infection that does not occur in immunocompetent individuals. HBV infection's major clinical importance seems to be after renal transplantation, as it can cause reactivation episodes that may be severe and leading to patient's death; moreover, dialysis centers present an opportunity for pathogen transmission [14]. Therefore, the aim of this study was to investigate the prevalence of occult HBV infection in patients receiving hemodialysis at a single center in Alexandria, Egypt.…”

Section: Introductionmentioning

confidence: 99%

Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt

Helaly¹,

Ghazzawi²,

Shawky³

et al. 2015

Journal of Infection and Public Health

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The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p=0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p=0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (p<0.05). In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.

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Outcomes and risk factors for hepatitis B virus (HBV) reactivation after kidney transplantation in occult HBV carriers

Abstract: In conclusion, our data showed that HBV reactivation may diminish the patient survival but not graft survival. Older age and anti-T-cell antibodies may increase the risk of HBV reactivation, whereas lamivudine prophylaxis may prevent HBV reactivation after kidney transplantation.

Cited by 49 publications

References 16 publications

Low prevalence of occult hepatitis B virus infection in chronic haemodialysis and kidney transplant patients

Low prevalence of occult hepatitis B virus infection in chronic haemodialysis and kidney transplant patients

Management of patients with hepatitis B who require immunosuppressive therapy

Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt

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