Factors associated with the intensity of liver fibrosis in renal transplant patients with hepatitis B virus infection.
BACKGROUND
Hepatitis B may show a more aggressive course after kidney transplantation, but the factors associated with the progression of fibrosis in this group have not been identified.


OBJECTIVE
To determine the influence of hepatitis B virus (HBV) viral load and host-related factors on the progression of hepatic fibrosis in hepatitis B virus-infected renal transplant recipients.


METHODS
Renal transplant patients positive for HBV surface antigen (HBsAg) and submitted to a liver biopsy because of evidence of viral replication were included. Patients with advanced fibrosis (METAVIR F3-F4) were compared with patients with mild fibrosis (F0-F2) regarding sex, age, estimated time since infection, post-transplant time, donor type, history of renal transplantation, alanine aminotransferase, anti-hepatitis C virus, HBeAg and quantitative hepatitis B virus-DNA. Logistic regression analysis was applied to identify variables independently associated with more advanced fibrosis.


RESULTS
Fifty-five patients (75% men, 41+/-11 years) with a mean post-transplant time of 5+/-4 years were included. HBeAg was detected in 67% of the patients and anti-hepatitis C virus in 35%. The median hepatitis B virus-DNA level was 2.8 x 10(8) copies/ml. Seventeen (31%) patients had advanced fibrosis. Using logistic regression analysis, the only variable that showed an independent association with more advanced stages of fibrosis was post-transplant time (P=0.03, odds ratio: 1.2, 95% confidence interval: 1.02-1.45).


CONCLUSIONS
Hepatitis B virus viral load, although very high, and hepatitis B virus/hepatitis C virus coinfection are not related to the intensity of liver fibrosis in renal transplant patients infected with hepatitis B virus. Post-transplant time was the only factor independently associated with more advanced liver fibrosis, suggesting the influence of immunosuppression on the progression of liver disease in these patients.
Matos
Carla A L
CA
Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
Perez
Renata M
RM
Lemos
Lara B
LB
Medina-Pestana
José O
JO
Lanzoni
Valeria P
VP
Alberto
Fernando L
FL
Moreira
Eloísa S
ES
Silva
Antonio Eduardo B
AE
Ferraz
Maria Lucia G
ML
D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D018450:Disease Progression; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000821:virology; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D016030:Kidney Transplantation; D008103:Liver Cirrhosis / Q000821:virology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011184:Postoperative Period; D012307:Risk Factors; D012720:Severity of Illness Index; D019562:Viral Load
D004279:DNA, Viral; D006513:Hepatitis B e Antigens