Presence of Hepatitis B Surface Antibody in Addition to Hepatitis B Core Antibody Confers Protection Against Hepatitis B Virus Infection in Hepatitis B Surface Antigen–negative Patients Undergoing Kidney Transplantation

Jeon, Jae Wan; Kim, So Mi; Cho, Hyung-Jin; Baek, Chung Hee; Kim, Hyosang; Shin, Sung; Kim, Young Hoon; Han, Duck Jong; Kim, Soon Bae

doi:10.1097/tp.0000000000002173

Cited by 16 publications

(14 citation statements)

References 21 publications

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“…The risk of HBsAg reversion is low in recipients who are HBsAg negative and anti-HBc positive. In a Korean cohort study of 951 recipients of kidney transplantation recipients with seronegative HBsAg/seropositive anti-HBc, the HBsAg reversion rate was 5.6% for anti-HBs negative patients, but there was no difference between anti-HBs-positive and anti-HBc-negative recipients [516]. However, because HBsAg reversion followed by liver failure was reported in recipients with seronegative HBsAg/seropositive anti-HBc, hepatitis B reactivation should be monitored regularly.…”

Section: Management In Special Conditionsmentioning

confidence: 99%

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KASL clinical practice guidelines for management of chronic hepatitis B

2019

Clin Mol Hepatol

184

107

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Background and Aims Clinical practice guidelines for the management of chronic hepatitis B (CHB) were originally published in 2004 by the Korean Association for the Study of the Liver (KASL) in order to provide specific medical information regarding CHB that would facilitate treatment of infected patients. Other than an update on treatment of antiviral resistance in 2014, which is a partial revision, the guidelines for the treatment of CHB have been revised entirely three times in 2007, 2011, and 2015. The Asian-Pacific Association for the Study of the Liver (APASL), the European Association for the Study of the Liver (EASL), and the American Association for the Study of Liver KASL clinical practice guidelines for management of chronic hepatitis B Korean Association for the Study of the Liver (KASL) *

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Section: Management In Special Conditionsmentioning

confidence: 99%

“…In patients who are ABO-incompatible and highly sensitized, rituximab is commonly used prior to renal transplantation. However, it can lead to liver failure in those with past HBV infection due to HBsAg reversion or HBV DNA redetection, albeit this risk is very low at low rituximab doses (200 mg) [516-518].…”

Section: Management In Special Conditionsmentioning

confidence: 99%

KASL clinical practice guidelines for management of chronic hepatitis B

2019

Clin Mol Hepatol

184

107

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“…[ 17 ] More recently, a retrospective study in Korea reported that the post-transplantation HBV infection rate was higher in anti-HBc-positive patients and undetectable anti-HBs than in those with detectable anti-HBs (5.6% vs 1.2%, P < .001). [ 22 ] In our study, anti-HBs titers prior to transplantation were available in 2 of the 3 cases of HBV reactivation, and in both patients they were <10 mIU/mL.…”

Section: Discussionmentioning

confidence: 91%

Anti-HBc impacts on the risk of hepatitis B reactivation but not on survival of solid-organ transplant recipients

Álvarez-López¹,

Riveiro‐Barciela

Oleas-Vega

et al. 2020

Medicine

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Immunosuppression can lead to hepatitis B virus (HBV) reactivation in hepatitis B core antigen antibodies (anti-HBc) positive patients, especially those undergoing chemotherapy, although there is limited data on solid organ recipients, especially lung transplantation. Our aim was to analyze the risk of HBV reactivation and the potential impact of anti-HBc-positive status (both donors and recipients) on prognosis in a lung, kidney, and liver transplantation cohort. Retrospective analysis including data from all transplants in adults (2011–2012) in a tertiary hospital, with prospective HBV serology study to assess the risk of reactivation and its possible impact on survival. In total, 392 transplant recipients were included (196 kidney, 113 lung, 83 liver). Pre-transplantation anti-HBc screening was more frequent in liver recipients ( P < .001) and donors ( P < .001) than in kidney or lung. Fifty-five (14%) recipients were anti-HBc-positive and were not undergoing antiviral prophylaxis. Three (5.4%) cases of HBV reactivation occurred: 2 in pre-transplant anti-HBc-positive recipients and 1 with prior unknown anti-HBc status. All were HBeAg+ with HBV deoxyribonucleic acid (DNA) >10E8 IU/mL and only mild fibrosis. Baseline recipient anti-HBc positive status was the only factor associated with HBV reactivation. No reactivation cases occurred in lung or kidney recipients of anti-HBc positive grafts. Survival was lower in lung transplants, especially in human immunodeficiency virus-infected patients and those with prior immunosuppression. Anti-HBc positive status is a risk factor for HBV reactivation in solid organ recipients. Anti-HBc testing is highly recommended in solid-organ transplant recipients in order to identify those anti-HBc positive and therefore candidates for periodical hepatitis B surface antigen (HBsAg) and HBV DNA screening after transplant.

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“…Cho et al [27] similarly observed no HBV reactivation in patients with prechemotherapy HBsAb titers >100 IU/mL, but the incidence of HBV reactivation was 8.3% at 6 months and 17.3% at 24 months postchemotherapy in those with HBsAb titers below this threshold. In addition, Jae Wan Jeon et al [28] found a significant difference in HBV infection rates between HBcAb(+) HBsAb(+) patients and HBcAb(+)HBsAb(-) patients (1.2% versus 5.6%; P < .001) in 1959 patients who underwent renal transplantation. Our results confirmed the protective function of HBsAbs in HBsAg(-)/HBcAb(+) HSCT recipients.…”

Section: Discussionmentioning

confidence: 98%

Determining Whether Prophylactic Antiviral Treatment Is Necessary in HBsAg-Negative/HBcAb-Positive Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation

Zhang

Tan

et al. 2020

Biology of Blood and Marrow Transplantation

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The incidence of hepatitis B virus (HBV) infection is high in the Asian population. Increasing attention is being given to the risk of HBV reactivation in hepatitis B core antibody-positive [HBcAb(+)] patients during immunosuppressive therapy. Knowledge of HBV reactivation in hematopoietic stem cell transplantation (HSCT) is limited. Moreover, the effect of hepatitis B surface antibody (HBsAb) on HBV reactivation in HBcAb(+) patients during HSCT remains uncertain. We sought to investigate the role of HBsAb and the need for prophylactic antiviral treatment in hepatitis B surface antigen-negative [HBsAg(-)]/HBcAb(+) patients during HSCT. We classified 665 HBsAg (-) HSCT recipients into 4 groups: HBcAb(-)HBsAb(-) (n = 189), HBcAb(-)HBsAb(+) (n = 176), HBcAb(+)HBsAb(-) (n = 49), and HBcAb(+)HBsAb(+) (n = 251). HBV reactivation was identified in 16 patients after HSCT. The median time to HBV reactivation was 645 days (range, 455 to 1957 days) after transplantation. The cumulative HBV reactivation rate was significantly higher in the HBcAb(+)HBsAb(-) group compared with the HBcAb(+)HBsAb(+), HBcAb (-)HBsAb(-), and HBcAb(-)HBsAb(+) groups, respectively (P< .001). Notably, the risk of HBV reactivation was significantly higher in the HBcAb(+)HBsAb(-) group compared with the HBcAb(+)HBsAb(+) group (P= .007; hazard ratio, 4.750; 95% confidence interval, 1.531 to 14.737). Our results point to a protective role of HBsAb in HBVresolved patients undergoing HSCT and indicate that prophylactic anti-HBV treatment might not be mandatory for HBsAg(-), HBcAb(+)HBsAb(+) patients following HSCT. The surveillance protocol of intense follow-up early (HBV DNA and HBsAg monthly) might not be necessary.

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Presence of Hepatitis B Surface Antibody in Addition to Hepatitis B Core Antibody Confers Protection Against Hepatitis B Virus Infection in Hepatitis B Surface Antigen–negative Patients Undergoing Kidney Transplantation

Abstract: The presence of anti-HBs confers protection against HBV infection. We recommend monitoring for HBV infection after KT in HBsAg(-) anti-HBc(+) anti-HBs(-) patients, but not in HBsAg(-) anti-HBc(+) anti-HBs(+) patients.

Cited by 16 publications

References 21 publications

KASL clinical practice guidelines for management of chronic hepatitis B

KASL clinical practice guidelines for management of chronic hepatitis B

Anti-HBc impacts on the risk of hepatitis B reactivation but not on survival of solid-organ transplant recipients

Determining Whether Prophylactic Antiviral Treatment Is Necessary in HBsAg-Negative/HBcAb-Positive Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation

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