Risk of hepatitis B reactivation in hepatitis B surface antigen seronegative and core antibody seropositive kidney transplant recipients

Abstract

Background: Previous contact with Hepatitis B virus (HBV) is common in patients undergoing hemodialysis. Literature has shown conflicting results on the risk of HBV reactivation in kidney transplant (KT) recipients with serologic evidence of past HBV infection. Methods: We reviewed 631 consecutive KT recipients and selected 70 patients simultaneously HBsAg negative and anti-HBc positive before KT, regardless of hepatitis B surface antibody (anti-HBs) status. Demographic characteristics, coinfection with other viruses, the presence of a previous KT, induction and maintenance immunosuppression, length of follow up, biopsy-proven acute rejection episodes, incidence of impaired liver function, and causes of graft loss and mortality were collected. Hepatitis B virus reactivation was defined as detection of HBV DNA viral load >2000 IU/mL during follow up. Outcome data included HBV reactivation episodes, graft function, and patient survival. Results: Median follow-up was 151 months; 91.4% of patients were positive to anti-HBs prior to KT. No patient received HBV prophylaxis and 11 patients (15.7%) received rituximab as part of induction therapy. Anti-HBs titers remained stable in all patients throughout the observation period but two patient showed evidence of HBV reactivation after KT.Conclusion: Hepatitis B virus reactivation in HBsAg-negative and anti-HBc-positive after KT is rare but possible. We suggest evaluating HBV serologies, HBV DNA viral load, and liver enzymes before KT and routinely monitoring serologic HBV markers after KT. As only two patients experienced HBV reactivation, it is neither possible to define risk factors for HBV reactivation nor to evaluate the impact of different immunosuppressants or the benefit of prophylactic regimens. Further studies regarding HBV reactivation in solid organ transplant recipients are necessary.

Hepatitis B reactivation after kidney transplantation in hepatitis B surface antigen‐negative, core antibody‐positive recipients

“…To date, several previous studies have reported the risk of HBV reactivation among HBsAg‐negative, anti‐HBc‐positive KT recipients. In these studies, the reported reactivation risk was low, ranging from 0.9% to 6.4% 17‐21 . Among studies that focused on the reactivation risk in recipients who received rituximab, one study found a very low risk of HBV reactivation (2.2%, one patient) among 48 patients who received rituximab, 22 whereas another study found a relatively high risk of HBV reactivation (10.2%, 5 patients) among 49 patients who used rituximab 15 .…”

“…In these studies, the reported reactivation risk was low, ranging from 0.9% to 6.4%. [17][18][19][20][21] Among studies that focused on the reactivation risk in recipients who received rituximab, one study found a very low risk of HBV reactivation (2.2%, one patient) among 48 patients who received rituximab, 22 whereas another study found a relatively high risk of HBV reactivation (10.2%, 5 patients) among 49 patients who used rituximab. 15 To the best of our knowledge, this study is the largest to date to report the risk of HBV reactivation including patients who used rituximab (n = 66), which was not high (3%, 3 patients).…”

Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program

“…Active HBV replicates had been detected in extrahepatic reservoirs such as lymph nodes, spleen, pancreas, and even brain, thus providing an extrahepatic source for a potential HBV reactivation 4,14 . However, the main source for HBV reactivation is the covalently linked cccDNA of HBV in the infected liver, which is removed at LT, thus explaining the difference in the HBV reactivation rate of 2.9% in a recently published study in 70 HBsAg‐negative/anti‐HBc‐positive kidney transplant recipients 15 . The median follow‐up time was comparable (12.0 vs 12.5 years), and no NA prophylaxis was administered in the analysis.…”

Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

“…These donors can also be offered to HBsAb+ recipients, who will not require antiviral prophylaxis. Post‐transplant HBV reactivation in HBsAg‐negative and HBcAb‐positive patients is rare but possible, so evaluation with HBV serologies, HBV viral load and liver enzymes before transplantation and monitoring serologic HBV markers after transplantation is suggested 111 . Patients who are not vaccinated against HBV or are HBV naïve can also receive HBcAb+ kidneys since the risk of transmission is low, but antiviral prophylaxis such as lamivudine for 1‐year post‐transplant is suggested in this setting.…”