title: Long-term outcome of Hepatitis B-positive renal allograft recipients after development of antiviral treatment.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) infection can adversely affect the clinical outcome of kidney transplantation (KT). Short-term efficacy of lamivudine has been demonstrated for chronic hepatitis B in KT recipients (KTR).
  
  
  METHODS
  To clarify the long-term impact of antiviral treatment for HBV-positive KTR, we retrospectively reviewed 94 HBV-positive (male 73%) and 282 age/sex-matched HBV-negative patients who underwent KT from February 1997 to November 2009, after lamivudine had come into wide use.
  
  
  RESULTS
  Mean follow-up was 75.7 months. 56 patients received antiviral agent for prophylaxis, and other 18 for HBV reactivation. During follow-up, 15 died, with 5 deaths being HBV related. Although the patient survival rate was lower for HBVpositive than HBV-negative KTRs (89% vs. 94% at 5 years, 78% vs. 88% at 10 years, p = 0.031), graft survival was comparable (86% vs. 92% at 5 years, 73% vs. 81% at 10 years, p = 0.113). In multivariate analysis, HBsAg positivity was a significant risk factor for patient death (OR 2.19, 95% CI 1.14 - 4.20, p = 0.019), but not significant for graft loss (OR 1.64, 95% CI 0.94 - 2.86, p = 0.079). Of the 26 hepatitis B e antigen (HBeAg)-positive patients, 14 experienced HBV reactivations, but all survived with stable liver chemistry, except for one who died of hepatocellular carcinoma. Among 57 HBeAg-negative patients, 12 died, whereas the remaining 45 survived without hepatic dysfunction.
  
  
  CONCLUSIONS
  Long-term outcomes of HBV-positive KTRs may be favorable after antiviral agents have been introduced.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Ulsan college of Medicine, Asan Medical Center, Songpa-gu, Seoul, South Korea. skpark@amc.seoul.kr
authors.forename: Kyung Sun
authors.initials: KS
authors.lastname: Park
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Park
authors.forename: Su- Kil
authors.initials: S
authors.lastname: Park
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006513:Hepatitis B e Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens