Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

• Published in: The Brazilian journal of infectious diseases Vol. 18; no. 6; pp. 625 - 630
• Main Authors: Emori, Christini Takemi, Perez, Renata Melo, de Matos, Carla Adriana Loureiro, Uehara, Silvia Naomi Oliveira, da Silva Fucuta Pereira, Patricia, Feldner, Ana Cristina Amaral, de Carvalho-Filho, Roberto José, de Souza e Silva, Ivonete Sandra, Silva, Antonio Eduardo Benedito, Ferraz, Maria Lucia Gomes
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01-11-2014; Contexto; Elsevier; Brazilian Society of Infectious Diseases
• Subjects: Acute Disease; Adolescent; Adult; Aged; ALT flare; Antiviral Agents - administration & dosage; Complications and side effects; Development and progression; Evaluation; Female; Hepatitis B; Hepatitis B, Chronic - drug therapy; Humans; INFECTIOUS DISEASES; Kidney transplantation; Kidney Transplantation - adverse effects; Lamivudine; Male; Middle Aged; Original; Preoperative care; Renal transplantation; Virus Replication; Young Adult; Renal transplantation; ALT flare; Lamivudine; Hepatitis B
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1016/j.bjid.2014.06.004

There is scarce information regarding clinical evolution of HBV infection in renal transplant patients.
To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis.
HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5× ULN and/or >3× baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis.
140 HBV-infected renal transplant patients were included (71% males; age 46±10 years; post-renal transplant time 8±5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4±3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect.
Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.