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HBsAg as predictor of outcome in renal transplant patients
Ezequiel Ridruejo1, María del Rosario Brunet, Ana Cusumano
1Sección Hepatología, Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina. eridruejo@cemic.edu.ar
Insights
Hepatitis B and C infections in kidney transplant recipients increase the risk of graft loss. While HBsAg positivity may increase mortality risk, this study found no statistically significant association with patient survival.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- Chronic hepatitis B and C virus infections are prevalent in renal transplant patients, affecting 1.5-50% globally.
- The impact of these viral infections on acute rejection, graft survival, and patient survival post-transplantation remains debated.
Purpose of the Study:
- To retrospectively evaluate the influence of hepatitis B and C virus status and other factors on acute rejection and survival outcomes in renal transplant patients.
- To identify risk factors associated with graft loss and patient mortality in this population.
Main Methods:
- Retrospective analysis of renal transplant patients between 1991 and 1998.
- Evaluation of factors including viral serology (antiHBc, antiHCV, HBsAg), age, ALT levels, acute rejection episodes, graft type, transplant history, and immunosuppression.
Main Results:
- Univariate analysis indicated that anti-HCV, HBsAg, anti-HBc status, multiple transplants, and acute rejection episodes were linked to reduced graft survival.
- Advanced age (>50) was associated with decreased patient survival. Multivariate analysis confirmed HBsAg positivity and rejection episodes as predictors of diminished graft survival.
- HBsAg positivity showed a non-statistically significant association with increased patient mortality risk.
Conclusions:
- Hepatitis C virus (anti-HCV) and hepatitis B virus (HBsAg) positive status are associated with an increased risk of renal graft loss.
- HBsAg positivity may be linked to a higher risk of death, though not statistically significant in this cohort.
Abstract:
Chronic liver infections related to hepatitis B and C viruses are a common problem in renal transplant patients with a prevalence of 1.5 to 50% in different countries. There is no uniform agreement regarding their influence on the incidence of acute rejection, graft outcome and survival of renal transplant patients. We retrospectively evaluated the influence of antiHBc, antiHCV and HBsAg positive status; gender; age over 50 years of age at the time of transplantation; pre and postransplantation alaninaminotransferase (ALT) elevation; acute rejection; type of graft; number of transplants; and maintenance and induction immunosuppression treatment on the incidence of acute rejection and both graft and patient survival in the population transplanted in our center between 1991 and 1998. The univariate analysis showed that antiHCV, HBsAg and antiHBc status, more than one renal transplant and one or more episodes of acute rejection were associated with diminished graft survival; and being over the age of 50 at the time of transplantation was also associated with diminished patient survival. In the multivariate analysis HBsAg positive and one or more episodes of rejection were associated with a diminished graft survival, and none of the variables studied was associated with diminished patient survival. In conclusion antiHCV and HBsAg positive status was associated with an increased risk of losing the transplanted kidney, and HBsAg positivity was associated with an increased risk of death, but this was not a statistically significant association.
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