title: Comparison of clinical outcomes in hepatitis B virus-positive kidney transplant recipients with or without pretransplantation antiviral therapy.
abstract: BACKGROUND
  Antiviral agents have improved the outcomes of hepatitis B virus (HBV)-positive kidney transplant recipients (KTRs). Preemptive therapy has been the main approach to forestall HBV reactivation. We sought to compare prophylactic and preemptive approaches.
  
  
  METHODS
  We divided the 69 HBV-positive KTRs into treatment and historical control groups, according to the time of starting pretransplantation antiviral therapy. The treatment group was further divided into prophylactic and preemptive therapy groups.
  
  
  RESULTS
  The treatment group showed a significant improvement in 10-year graft (82% vs 34%) and patient (91% vs 57%) survivals. Among the historical control group, the main causes of graft failure were patient deaths (68%), which were mostly caused by liver diseases. In contrast, there was no liver-related death in the treatment group. In addition, there was no difference in graft or patient survival between the prophylactic and preemptive groups, but the incidence of HBV reactivation was lower in the prophylactic group. Antiviral therapy was an independent factor for the improved patient survival (P = .005).
  
  
  CONCLUSIONS
  Pretransplantation antiviral therapy is essential to improve clinical outcomes. Prophylactic may be better than preemptive antiviral therapy to decrease HBV reactivation.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: H G
authors.initials: HG
authors.lastname: Kim
authors.forename: E Y
authors.initials: EY
authors.lastname: Kim
authors.forename: Y J
authors.initials: YJ
authors.lastname: Yu
authors.forename: G H
authors.initials: GH
authors.lastname: Kim
authors.forename: J W
authors.initials: JW
authors.lastname: Jeong
authors.forename: J H
authors.initials: JH
authors.lastname: Byeon
authors.forename: B H
authors.initials: BH
authors.lastname: Chung
authors.forename: C W
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006509:Hepatitis B / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents