title: Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients.
abstract: BACKGROUND
  There is scarce information regarding clinical evolution of HBV infection in renal transplant patients.
  
  
  OBJECTIVE
  To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis.
  
  
  METHODS
  HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5× ULN and/or >3× baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis.
  
  
  RESULTS
  140 HBV-infected renal transplant patients were included (71% males; age 46 ± 10 years; post-renal transplant time 8 ± 5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4 ± 3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect.
  
  
  CONCLUSIONS
  Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: christinisp@yahoo.com.br.
authors.forename: Christini Takemi
authors.initials: CT
authors.lastname: Emori
authors.affiliation: Internal Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
authors.forename: Renata Melo
authors.initials: RM
authors.lastname: Perez
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Carla Adriana Loureiro de
authors.initials: CA
authors.lastname: Matos
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Silvia Naomi Oliveira
authors.initials: SN
authors.lastname: Uehara
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Patricia da Silva Fucuta
authors.initials: Pda S
authors.lastname: Pereira
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Ana Cristina Amaral
authors.initials: AC
authors.lastname: Feldner
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Roberto José de
authors.initials: RJ
authors.lastname: Carvalho-Filho
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Ivonete Sandra de Souza e
authors.initials: IS
authors.lastname: Silva
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Antonio Eduardo Benedito
authors.initials: AE
authors.lastname: Silva
authors.affiliation: Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Maria Lucia Gomes
authors.initials: ML
authors.lastname: Ferraz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D005260:Female; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014779:Virus Replication; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: ALT flare; Hepatitis B; Lamivudine; Renal transplantation