Significant rate of hepatitis B reactivation following kidney transplantation in patients with resolved infection

Kanaan, Nada; Kabamba, Benoît; Maréchal, Céline; Pirson, Yves; Beguin, Claire; Goffin, Éric; Hassoun, Ziad

doi:10.1016/j.jcv.2012.07.015

Cited by 59 publications

(56 citation statements)

References 37 publications

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“…30,78 In HBsAg-negative–anti-HBc-positive patients, those who have an undetectable anti-HBs level at the onset of immunosuppressive therapy or have a loss of anti-HBs during immunosuppressive therapy have an increased risk of HBV reactivation. 26,43,79,80 …”

Section: Viral Factorsmentioning

confidence: 99%

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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Section: Viral Factorsmentioning

confidence: 99%

Management of patients with hepatitis B who require immunosuppressive therapy

Hwang

Lok

2013

Nat Rev Gastroenterol Hepatol

218

177

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“…The association between HBV DNA levels and risk of reactivation is likely also true for anti-HBc positive patients [34]. In patients who are HBsAg-negative and anti-HBc-positive, anti-HBs level is thought to be a factor as well, with those having undetectable anti-HBs level at the onset of immunosuppressive therapy and those who have loss of anti-HBs during immunosuppressive therapy at increased risk for reactivation [35, 36]. The association between the virologic and serologic status of the host and reactivation risk is likely to be explained by a spectrum of immunologic control over HBV, with HBeAg-positive, highly viremic HBsAg carriers at one extreme and non-viremic, anti-HBc/anti-HBs-positive patients at the other.…”

Section: Viral Factorsmentioning

confidence: 99%

Immunosuppression in Patients with Chronic Hepatitis B

Seetharam

Perrillo

Gish

2014

Curr Hepatology Rep

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After hepatitis B virus (HBV) infection, HBV DNA persists in minute amounts in hepatocyte nuclei even in individuals with “resolved” infection. Viral replication and development of liver disease depend on the balance between viral mechanisms promoting persistence and host immune control. Patients with active or inactive disease or resolved HBV infection are at risk for reactivation with immunosuppressive therapy use. HBV reactivation varies from a clinically asymptomatic condition to one associated with acute liver failure and death. We review recent studies on HBV reactivation during immunomodulatory therapies for oncologic, gastroenterological, rheumatic, and dermatologic disorders. Risk calculation should be determined through HBV screening and assessment of immunosuppressive therapy potency. We also discuss monitoring for reactivation, prophylactic antiviral therapy, and treatment of reactivation. Prophylactic antiviral treatment is needed for all HBsAg carriers and selected patients who have anti-HBc without HBsAg and is critical for preventing viral reactivation and improving outcomes.

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“…However, the study by Kanan et al, revealed that the patients without anti-HBs titers at transplantation were 26 times more likely to develop reactivation compared to those with anti-HBs titers [4,5]. Moreover the patients who became anti-HBs negative after KT had a pre-transplant antibody titer below 100 IU/L [5]. In comparison, patients with pre-transplant anti-HBs antibody level>100 IU/L did not experience re-activation.…”

Section: Discussionmentioning

confidence: 98%

“…The reported incidence of reactivation varies from 0%-6.5% in KTRs and these studies also suggested that if reactivation occurs, its consequences are benign [3]. However, the study by Kanan et al, revealed that the patients without anti-HBs titers at transplantation were 26 times more likely to develop reactivation compared to those with anti-HBs titers [4,5]. Moreover the patients who became anti-HBs negative after KT had a pre-transplant antibody titer below 100 IU/L [5].…”

Section: Discussionmentioning

confidence: 99%

Role of Anti-Hbs Titer to Prevent Reactivation of Hepatitis B after Kidney Transplant in a Patient with Resolved Hepatitis B Infection: A Case Report and Review of Literature

Kumar

2017

GHR

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Significant rate of hepatitis B reactivation following kidney transplantation in patients with resolved infection

Cited by 59 publications

References 37 publications

Management of patients with hepatitis B who require immunosuppressive therapy

Management of patients with hepatitis B who require immunosuppressive therapy

Immunosuppression in Patients with Chronic Hepatitis B

Role of Anti-Hbs Titer to Prevent Reactivation of Hepatitis B after Kidney Transplant in a Patient with Resolved Hepatitis B Infection: A Case Report and Review of Literature

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