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HBV reactivation after kidney transplantation
Annemarie Berger1, Wolfgang Preiser, Hans Georg Kachel
1Institute for Medical Virology, Center of Internal Medicine, J.W. Goethe University Hospital, Paul Ehrlich-Str. 40, D-60596 Frankfurt a. M., Germany. Annemarie.Berger@em.uni-frankfurt.de
Summary
Hepatitis B virus (HBV) reactivation can occur in kidney transplant recipients with resolved infections. Natural immunity may not prevent reactivation under immune suppression, necessitating regular serological monitoring.
Area of Science:
- Hepatology
- Transplant Immunology
- Virology
Background:
- Hepatitis B virus (HBV) infection is a global health concern.
- Resolved HBV infection (anti-HBc positive, HBsAg negative) is common in potential transplant candidates.
- Immunosuppression post-transplantation can affect latent viral infections.
Observation:
- This study reviewed 1512 kidney transplant recipients with resolved HBV infection.
- Two patients (0.9%) experienced reappearance of hepatitis B surface antigen (HBsAg) post-transplantation.
- Reactivation occurred despite low-level immunosuppression.
Findings:
- Reappearance of HBsAg suggests reactivation of latent HBV or new infection.
- Natural immunity to HBV may be insufficient to prevent reactivation in immunosuppressed individuals.
- Low-level immunosuppression was sufficient to trigger reactivation in these cases.
Implications:
- Kidney transplant recipients with resolved HBV infection are at risk of reactivation.
- Periodic monitoring of HBV serology is crucial for early detection in transplant recipients.
- Current understanding of protective immunity against HBV reactivation needs re-evaluation in immunosuppressed populations.