Hepatitis B Reactivation After Kidney Transplantation in Hepatitis B Surface Antigen-Positive Recipients

Hepatitis B virus reactivation in HBsAg -positive kidney transplant recipients sometimes results in liver failure and death. Although current guidelines recommend continuing antiviral therapy for ≥6 months after the last dose of immunosuppressive therapy, in transplant recipients, duration is uncertain because immunosuppressive therapy is lifelong. Here, we evaluated the incidence and effects of hepatitis B virus reactivation in kidney transplant recipients with hepatitis B virus infection.

We reviewed patients who underwent kidney transplant between 2012 and 2023; we excluded patients with missing hepatitis B serology, those who were hepatitis B surface antigen negative /anti -HBc negative, those with total follow -up of <1 year, and those with coinfection. Hepatitis B virus reactivation was defined as at least a 100 -fold increase in hepatis B virus DNA levels in patients with previously detectable or levels that were negative before becoming positive.

In 21 hepatitis B surface antigen -positive kidney transplant recipients, mean age was 45.8 ± 8.5 years, 76 % were male, and 62 % had living donor transplant. Mean follow -up was 86 ± 32 months. Seven transplant recipients received antiviral treatment (3 with entecavir, 3 with tenofovir disoproxil fumarate, 1 with lamivudine ). Among 14 patients without antiviral treatment, 7 had positive HBV DNA ( >69 IU /mL ) at time of transplant All recipients received prophylactic antiviral therapy (14 received entecavir, 4 received lamivudine, 3 received tenofovir disoproxil fumarate ) concomitant with transplant. During follow -up, hepatitis B virus reactivation was observed in 25 % of patients who received lamivudine. No serious adverse outcomes, including liver transplant or death, due to HBV reactivation were observed.

Although optimal duration of prophylactic antiviral therapy remains unclear, entecavir or tenofovir was the preferred antiviral therapy over lamivudine for hepatitis B virus reactivation prophylaxis. Close monitoring with antiviral prophylaxis is the optimal strategy to prevent hepatitis B virus reactivation during immunosuppressive therapy.