Risk Stratification for Hepatitis B Virus Reactivation in Kidney Transplant Recipients With Resolved HBV Infection

Area of Science:

• Nephrology
• Hepatology
• Immunology

Background:

• Hepatitis B virus (HBV) reactivation poses a significant risk in kidney transplant recipients (KTRs).
• The optimal prophylaxis strategy for KTRs with resolved HBV infection is not well-defined.
• Assessing risk factors for HBV reactivation is crucial for KTR management.

Purpose of the Study:

• To investigate the incidence of HBV reactivation in KTRs with resolved HBV infection.
• To identify independent risk factors associated with HBV reactivation in this population.
• To propose a risk-stratified approach for HBV antiviral prophylaxis in KTRs.

Main Methods:

• Retrospective cohort study of KTRs with resolved HBV infection from 2000-2020.
• Patients were categorized into anti-HBs positive and anti-HBs negative groups.
• Competing risk analysis was used to determine cumulative incidences and subdistribution hazard ratios (SHRs) for HBV reactivation.

Main Results:

• The 10-year cumulative incidence of HBV reactivation was significantly higher in the anti-HBs negative group (15.2%) compared to the anti-HBs positive group (1.3%).
• Absence of anti-HBs (SHR 14.2) and high-dose steroid use (prednisolone equivalent ≥20 mg/day for >4 weeks, SHR 8.96) were independent risk factors for HBV reactivation.
• The 10-year cumulative incidence of HBV reactivation increased with the number of risk factors: 42.7% for two, 7.9% for one, and 0% for zero risk factors.

Conclusions:

• HBV reactivation risk is significantly elevated in KTRs lacking anti-HBs antibodies.
• Risk stratification based on anti-HBs serostatus and steroid dosage is essential for tailoring HBV prophylaxis.
• A personalized prophylaxis strategy can potentially mitigate HBV reactivation in KTRs.