Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients
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 evolutio...
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| Published in: | The Brazilian journal of infectious diseases Vol. 18; no. 6; pp. 625 - 630 |
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| Abstract | 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. |
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| AbstractList | 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. INTRODUCTIONThere is scarce information regarding clinical evolution of HBV infection in renal transplant patients. AIMSTo 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. MATERIALS AND METHODSHBV 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. RESULTS140 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. CONCLUSIONSAcute 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. Introduction: There is scarce information regarding clinical evolution of HBV infection in renal transplant patients. Aims: 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. Materials and methods: 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. Results: 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. Conclusions: 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. Keywords: Renal transplantation, Hepatitis B, ALT flare, Lamivudine Introduction: There is scarce information regarding clinical evolution of HBV infection in renal transplant patients. Aims: 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. Materials and methods: HBV infected renal transplant patients who underwent regular followup visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5x ULN and/or >3x 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. Results: 140 HBV-infected renal transplant patients were included (71% males; age 46 [+ or -] 10 years; post-renal transplant time 8 [+ or -] 5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4 [+ or -] 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. Conclusions: 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. Keywords: Renal transplantation Hepatitis B ALT flare Lamivudine 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. Introduction:There is scarce information regarding clinical evolution of HBV infection in renal transplant patients.Aims: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.Materials and methods: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.Results: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.Conclusions: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. |
| Audience | Academic |
| Author | Emori, Christini Takemi Perez, Renata Melo Feldner, Ana Cristina Amaral Silva, Antonio Eduardo Benedito de Carvalho-Filho, Roberto José Uehara, Silvia Naomi Oliveira de Matos, Carla Adriana Loureiro de Souza e Silva, Ivonete Sandra da Silva Fucuta Pereira, Patricia Ferraz, Maria Lucia Gomes |
| AuthorAffiliation | Universidade Federal do Rio de Janeiro Universidade Federal de São Paulo |
| AuthorAffiliation_xml | – name: Universidade Federal do Rio de Janeiro – name: Universidade Federal de São Paulo |
| Author_xml | – sequence: 1 givenname: Christini Takemi surname: Emori fullname: Emori, Christini Takemi email: christinisp@yahoo.com.br organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 2 givenname: Renata Melo surname: Perez fullname: Perez, Renata Melo organization: Internal Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil – sequence: 3 givenname: Carla Adriana Loureiro surname: de Matos fullname: de Matos, Carla Adriana Loureiro organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 4 givenname: Silvia Naomi Oliveira surname: Uehara fullname: Uehara, Silvia Naomi Oliveira organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 5 givenname: Patricia surname: da Silva Fucuta Pereira fullname: da Silva Fucuta Pereira, Patricia organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 6 givenname: Ana Cristina Amaral surname: Feldner fullname: Feldner, Ana Cristina Amaral organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 7 givenname: Roberto José surname: de Carvalho-Filho fullname: de Carvalho-Filho, Roberto José organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 8 givenname: Ivonete Sandra surname: de Souza e Silva fullname: de Souza e Silva, Ivonete Sandra organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 9 givenname: Antonio Eduardo Benedito surname: Silva fullname: Silva, Antonio Eduardo Benedito organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil – sequence: 10 givenname: Maria Lucia Gomes surname: Ferraz fullname: Ferraz, Maria Lucia Gomes organization: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil |
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| CitedBy_id | crossref_primary_10_1016_j_transproceed_2018_07_028 crossref_primary_10_9738_INTSURG_D_15_00144_1 crossref_primary_10_1111_tid_12482 crossref_primary_10_1016_j_trim_2022_101723 crossref_primary_10_1128_microbiolspec_DMIH2_0025_2015 |
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| Keywords | Renal transplantation ALT flare Lamivudine Hepatitis B |
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A prospective study of 90 patients publication-title: Gastroenterology – volume: 39 start-page: 610 year: 1985 end-page: 615 article-title: The impact of renal transplantation on the course of hepatitis B liver disease publication-title: Transplantation – volume: 52 start-page: 3440 year: 2007 end-page: 3443 article-title: Clinical course of hepatitis B virus infection in renal allograft recipients publication-title: Dig Dis Sci – volume: 29 start-page: 257 year: 1999 end-page: 263 article-title: Impact of hepatitis B and C virus on kidney transplantation outcome publication-title: Hepatology – volume: 27 start-page: 322 year: 1989 end-page: 328 article-title: High frequency of hepatitis B virus DNA in anti-HBe positive sera on longitudinal follow-up of patients with renal transplants and chronic hepatitis B publication-title: J Med Virol – volume: 32 start-page: 828 year: 2000 end-page: 834 article-title: Long-term therapy of chronic hepatitis B with lamivudine publication-title: Hepatology – volume: 38 start-page: 1074 year: 2001 end-page: 1081 article-title: Lamivudine is effective for the treatment of reactivation of hepatitis B virus and fulminant hepatic failure in renal transplant recipients publication-title: Am J Kidney Dis – volume: 86 start-page: 162 year: 1984 end-page: 165 article-title: Azathioprine and the liver. 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Incidence, predisposing factors and etiology publication-title: J Hepatol – volume: 50 start-page: 1 year: 2001 end-page: 43 article-title: Recommendations for preventing transmission of infections among chronic hemodialysis patients publication-title: MMWR Recomm Rep – volume: 52 start-page: 416 year: 2003 end-page: 419 article-title: A large population study of spontaneous HBeAg seroconversion and acute exacerbation of chronic hepatitis B infection: implications for antiviral therapy publication-title: Gut – volume: 19 start-page: 653 year: 2007 end-page: 657 article-title: Factors associated with the intensity of liver fibrosis in renal transplant patients with hepatitis B virus infection publication-title: Eur J Gastroenterol Hepatol – volume: 83 start-page: 1627 year: 1986 end-page: 1631 article-title: Hepatitis B virus DNA contains a glucocorticoid-responsive element publication-title: Proc Natl Acad Sci U S A – volume: 11 start-page: 97 year: 2004 end-page: 107 article-title: Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures publication-title: J Viral Hepat – volume: 69 start-page: 2090 year: 2000 end-page: 2094 article-title: HBV genotypic resistance to lamivudine in kidney recipients and hemodialyzed patients publication-title: Transplantation – volume: 3 start-page: 330 year: 1983 end-page: 336 article-title: Natural history of hepatitis B virus infection in renal transplant recipients-a fifteen-year follow-up publication-title: Hepatology – volume: 62 start-page: 297 year: 1996 end-page: 299 article-title: The long-term virologic and pathologic impact of renal transplantation on chronic hepatitis B virus infection publication-title: Transplantation – volume: 24 start-page: 289 year: 1996 end-page: 293 article-title: An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group publication-title: Hepatology |
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To evaluate the prevalence of acute exacerbation in... Introduction: There is scarce information regarding clinical evolution of HBV infection in renal transplant patients. Aims: To evaluate the prevalence of acute... INTRODUCTIONThere is scarce information regarding clinical evolution of HBV infection in renal transplant patients. AIMSTo evaluate the prevalence of acute... Introduction:There is scarce information regarding clinical evolution of HBV infection in renal transplant patients.Aims:To evaluate the prevalence of acute... |
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| SubjectTerms | 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 |
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| Title | Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients |
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