Clinical Outcome of Renal Transplantation in Patients with Positive Pretransplant Hepatitis B Surface Antigen.
- Author:
Hyung Joon AHN
1
;
Myoung Soo KIM
;
Soon Il KIM
;
Jong Hoon LEE
;
Man Ki JU
;
Yu Seun KIM
;
Kyung Ock JEON
;
Hyun Jung KIM
Author Information
1. Department of Transplantation Surgery, Severance Hospital Transplantation Center, Seoul, Korea. yukim@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Pre-transplant HBs antigen;
Renal transplantation;
Lamivudine
- MeSH:
Carcinoma, Hepatocellular;
DNA;
Follow-Up Studies;
Graft Survival;
Hepatitis B Surface Antigens*;
Hepatitis B*;
Hepatitis*;
Humans;
Immunosuppression;
Kidney Transplantation*;
Lamivudine;
Liver Failure;
Mortality;
Natural History;
Polymerase Chain Reaction;
Retrospective Studies;
Suicide;
Survival Rate;
Transplantation;
Viral Load
- From:The Journal of the Korean Society for Transplantation
2006;20(1):79-83
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The natural history of renal transplant recipients with positive HBs Ag is still unclear and unpredictable. Liver-related morbidity and mortality after long-term immunosuppression need clinical challenges. We retrospectively investigated the clinical outcome of pre-transplant HBs Ag positive renal recipients in a single transplant center located in endemic area. METHODS: After excluding post-transplant de novo HBV infected, and peri-transplant anti-hepatitis C virus positive recipients, the clinical outcome of 1,816 recipients was examined by the nature of pre-transplant HBs Ag positivity. RESULTS: Pre-transplant HBs Ag positivity was documented in 61 recipients (M/F=47/14). During mean follow up of 71.61+/-54.14 months, 24 recipients died (6 by infection, 12 by hepatic failure, 2 by hepatocellular carcinoma, 2 by other malignancies, 1 by suicide, 1 by gastrointestinal bleeding). In 14 recipients (58.3%), death was related to liver-associated reasons. The 10-year patient survival rates in HBs Ag negative and positive groups were 90.0% and 62.6%, respectively (P<0.0001). The 10-year graft survival rates in HBs Ag negative and positive groups were 82.0% and 55.6%, respectively (P<0.0001). When pre-transplant HBV DNA viral load by PCR was positive or when the level of post-transplant HBV-DNA viral load flared up, we started lamivudine therapy since 1997. Seventeen recipients received daily 100 mg lamivudine. The mean duration of patients survival with (n=17) and without (n=44) lamivudine therapy was 104.3+/-45.6 and 59.0+/-51.2 months, respectively (P= 0.003). The 10-year patient survival rates in patients with and without lamivudine therapy were 80.7% and 55.4%, respectively (P=0.0698). CONCLUSION: Overall patient and graft survival in patients with positive pre-transplant HBs Ag was lower than negative recipients. Although, statistically not significant, lamivudine therapy showed a marginally positive impact on the survival of patients with pre-transplant positive HBs Ag.
