title: Factors associated with the intensity of liver fibrosis in renal transplant patients with hepatitis B virus infection.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Carla A L
authors.initials: CA
authors.lastname: Matos
authors.forename: Renata M
authors.initials: RM
authors.lastname: Perez
authors.forename: Lara B
authors.initials: LB
authors.lastname: Lemos
authors.forename: José O
authors.initials: JO
authors.lastname: Medina-Pestana
authors.forename: Valeria P
authors.initials: VP
authors.lastname: Lanzoni
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Alberto
authors.forename: Eloísa S
authors.initials: ES
authors.lastname: Moreira
authors.forename: Antonio Eduardo B
authors.initials: AE
authors.lastname: Silva
authors.forename: Maria Lucia G
authors.initials: ML
authors.lastname: Ferraz
mesh_terms: 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
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens