title: Pretransplant Hepatitis B Viral Infection Increases Risk of Death After Kidney Transplantation: A Multicenter Cohort Study in Korea.
abstract: Clinical outcomes in kidney transplant recipients (KTRs) with hepatitis B virus (HBV) have not been thoroughly evaluated. Here, we investigated recent posttransplant clinical outcomes of KTRs with HBV and compared them with KTRs with hepatitis C virus (HCV) and seronegative KTRs.Of 3855 KTRs from April 1999 to December 2011, we enrolled 3482 KTRs who had viral hepatitis serology data; the patients were followed up for 89.1 ± 54.1 months. The numbers of recipients with HBV and HCV were 160 (4.6%) and 55 (1.6%), respectively. We analyzed the clinical outcomes, including overall mortality and graft failure, among patients who had undergone kidney transplantation.Patients with HBV showed poorer survival (P = 0.019; adjusted hazard ratio [HR] = 2.370; 95% confidence interval [CI]: 1.155-4.865) than KTRs without HBV. However, the graft survival of patients with chronic hepatitis B did not differ from that of patients without HBV. Hepatic complications were the primary causes of mortality of KTRs with HBV. Mortality significantly correlated with a higher grade of inflammation (P = 0.002) and with the use of lamivudine or adefovir antiviral treatment (P = 0.016). HBV-positive KTRs treated with the new-generation antiviral agent entecavir showed improved patient survival compared with KTRs receiving lamivudine (log-rank P = 0.050). HCV did not affect patient survival; however, it increased the incidence of graft failure (P = 0.010; adjusted HR = 2.899; 95% CI: 1.289-6.519). KTRs with HCV had an increased incidence of acute rejection (log-rank P = 0.005, crude HR = 2.144; 95% CI: 1.341-3.426; P = 0.001).KTRs with chronic hepatitis B may exhibit poor survival due to post-transplantation hepatic complications. Pretransplant histological liver evaluations and adequate antiviral management with potent nucleoside/nucleotide analogues are needed to improve the survival of KTRs with chronic hepatitis B even when liver function is within the normal range.
authors.affiliation: From the Internal Medicine (JL), Hallym University Hangang Sacred Heart Hospital, Seoul; Internal Medicine (JHC, CDK), Kyungpook National University Hospital, Daegu; Department of Internal Medicine (JSL), Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan; Internal Medicine (DWA, CSL, JPY), Seoul National University Boramae Medical Center; Internal Medicine (CA, YSK), Seoul National University Hospital; Surgery (IMJ), Seoul National University Boramae Medical Center; Surgery (DJH, YHK), Ulsan University Seoul Asan Medical Center, Seoul, Korea.
authors.forename: Jeonghwan
authors.initials: J
authors.lastname: Lee
authors.forename: Jang-Hee
authors.initials: JH
authors.lastname: Cho
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Lee
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Ahn
authors.forename: Chan-Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
authors.forename: In Mok
authors.initials: IM
authors.lastname: Jung
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Lim
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Jung Pyo
authors.initials: JP
authors.lastname: Lee
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications* / Q000601:surgery*; D056910:Republic of Korea / Q000453:epidemiology; D062606:Tertiary Care Centers
chemical_list: D000998:Antiviral Agents