Rituximab and hepatitis B reactivation in HBsAg-negative/ anti-HBc-positive kidney transplant recipients.
Hepatitis B virus (HBV) reactivation is a well-known complication of immunosuppressive therapy. Although rituximab is increasingly used for desensitization of ABO-incompatible or positive crossmatch kidney transplantation, the risk of HBV reactivation in hepatitis B surface antigen (HBsAg)-negative/hepatitis B core antibody (anti-HBc)-positive kidney transplant patients receiving rituximab desensitization remains undetermined.



We analysed 172 resolved HBV patients who underwent living donor kidney transplantation between 2008 and 2014. Patients were divided into rituximab ( n  =  49) or control ( n  =  123) groups. All patients were observed for HBV reactivation, which was defined as the reappearance of hepatitis B surface antigen or HBV DNA.



During the follow-up period (median, 58 months; range, 4-95 months), five patients (10.2%) in the rituximab group and two patients (1.6%) in the control group experienced HBV reactivation (P   =   0.003). In the rituximab group, two patients experienced HBV-related severe hepatitis, and one patient died due to hepatic failure. The median time from rituximab desensitization to HBV reactivation was 11 months (range, 5-22 months). By contrast, no patients in the control group experienced severe hepatitis. The status of hepatitis B surface antibody was similar between groups. Rituximab desensitization [hazard ratio (HR), 9.18; 95% confidence interval (CI), 1.74-48.86; P   =   0.009] and hepatitis B surface antibody status (HR, 4.74; 95% CI, 1.05-21.23, P =   0.04) were significant risk factors for HBV reactivation.



Rituximab desensitization for incompatible kidney transplantation significantly increased the risk of HBV reactivation in HBsAg-negative/anti-HBc-positive patients. Therefore, close monitoring of HBV DNA is required in these patients.
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Juhan
J
Lee
Department of Gastroenterology, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.|Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jun Yong
JY
Park
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.|The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
Kyu Ha
KH
Huh
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.|The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.|Department of Nephrology, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
Beom Seok
BS
Kim
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.|The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
Myoung Soo
MS
Kim
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.|The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
Soon Il
SI
Kim
Department of Gastroenterology, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.|Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sang Hoon
SH
Ahn
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.|The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
Yu Seun
YS
Kim
D000970:Antineoplastic Agents / Q000494:pharmacology; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D000069283:Rituximab / Q000494:pharmacology*; D066027:Transplant Recipients; D014775:Virus Activation / Q000187:drug effects*
D000970:Antineoplastic Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D000069283:Rituximab
hepatitis B virus; immunosuppression; kidney transplantation; reactivation; rituximab