title: Outcomes of Kidney Transplantation in Patients Exposed to Hepatitis B Virus: Analysis by Phase of Infection.
abstract: BACKGROUND
  In kidney transplant recipients (KTRs) with hepatitis B virus (HBV) infection, immunosuppression may increase viral replication with increased risk for liver disease progression and HBV-related kidney diseases, factors that could adversely influence graft and patient outcomes. We aimed to analyze the impact of different phases of HBV infection on the outcomes in KTRs.
  
  
  METHODS
  Using the Organ Procurement and Transplant Network/United Network for Organ Sharing database, we selected adult KTRs from 2001 to 2011 who received peri-operative antibody induction followed by calcineurin inhibitor/mycophenolate mofetil maintenance with/without steroid. The cohort was divided into 4 groups, based on the presence/absence of hepatitis B surface antigen (HBsAg) and core antibody (HBcAb) at the time of transplantation: group 1: HBsAg+/HBcAb- (acute infection); group 2: HBsAg+/HBcAb+ (developing immune response); group 3; HBsAg-/HBcAb+ (resolving infection); and group 4: HBsAg-/HBcAb- (HBV-naive). Graft and patient survivals were compared among the groups in a multivariate Cox model.
  
  
  RESULTS
  Adjusted overall graft (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.90-1.10; P = .58) and patient (HR, 0.95; 95% CI, 0.83-1.09; P = .52) survival rates were similar between groups 1 and 2, with inferior death-censored graft survival in group 1 (HR, 0.83; 95% CI, 0.71-0.98; P = .02). Adjusted over all graft (HR, 1.0; 95% CI, 0.90-1.00; P = .46) and patient (HR, 1.03; 95% CI, 0.90-1.10; P = .10) survival rates were similar between groups 3 and 4, and death-censored graft survival trended inferior in group 3 (HR, 0.97; 95% CI, 0.90-1.00; P = .05).
  
  
  CONCLUSIONS
  Our analysis supports a practice of delaying kidney transplantation in HBV-infected patients until they develop an immune response and preferably until the infection is cleared.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: B
authors.initials: B
authors.lastname: Chopra
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania. Electronic address: kalathil.sureshkumar@ahn.org.
authors.forename: K K
authors.initials: KK
authors.lastname: Sureshkumar
mesh_terms: D000328:Adult; D000917:Antibody Formation / Q000276:immunology; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D009927:Tissue and Organ Procurement; D014181:Transplantation Immunology / Q000276:immunology; D014779:Virus Replication / Q000276:immunology
chemical_list: D065095:Calcineurin Inhibitors; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D013256:Steroids; D009173:Mycophenolic Acid