A multicenter evaluation of hepatitis B reactivation with and without antiviral prophylaxis after kidney transplantation

• Published in: Transplant infectious disease 2022-02, Vol.24 (1), p.e13751-n/a
• Main Authors: Shaikh, Suhail A, Kahn, Jeffrey, Aksentijevic, Andraea, Kawewat‐Ho, Pnada, Bixby, Alexandra, Rendulic, TrisAnn, Park, Jeong M
• Format: Article
• Language: English
• Subjects: Antibodies; Antigens; Antiviral Agents - pharmacology; Antiviral Agents - therapeutic use; antiviral prophylaxis; Biopsy; Disease prevention; Evaluation; Graft rejection; Grafting; Hepatitis; Hepatitis B; Hepatitis B - drug therapy; Hepatitis B - epidemiology; Hepatitis B - prevention & control; Hepatitis B Antibodies; Hepatitis B surface antigen; Hepatitis B Surface Antigens; Hepatitis B virus - genetics; Humans; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Prophylaxis; Rejection; Retrospective Studies; Risk analysis; Risk factors; Statistical analysis; Virus Activation
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13751

Background Hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)‐negative and hepatitis B core antibody (anti‐HBc)‐positive kidney transplant recipients ranges between 1.4% and 9.6%. Limited evidence is available regarding routine antiviral prophylaxis and identifiable risk factors for HBV reactivation in this population. Methods In this multicenter retrospective study, we evaluated the prevalence of HBV reactivation in HBsAg‐negative anti‐HBc‐positive kidney transplant recipients who did or did not receive antiviral prophylaxis. The primary outcome assessed the prevalence of HBV reactivation, defined as a positive HBV DNA by PCR of any viral load at or above the minimal detection level. The principal safety outcomes assessed 1‐year graft survival, 1‐year all‐cause mortality, biopsy‐proven acute rejection, and antibody‐mediated rejection. Results One hundred and sixty‐one patients met inclusion criteria and comprised two groups, antiviral prophylaxis (n = 14) and no antiviral prophylaxis (n = 147). Of patients who did not receive prophylaxis, only five (3.4%) experienced HBV reactivation, whereas one (7.1%) patient in the prophylaxis group experienced reactivation over a median follow‐up of 1103 days (p = .43). Furthermore, there were no differences with respect to all secondary outcomes. Statistical analysis demonstrated delayed graft function to be a significant factor associated with HBV reactivation. Conclusion These study results suggest that the prevalence of HBV reactivation in HBsAg‐negative anti‐HBc‐positive kidney transplant recipients is low, regardless of antiviral prophylaxis. Furthermore, there were no significant graft‐related outcomes among those that did experience reactivation.