Hepatitis antigenemia and survival after renal transplantation

Some transplant programs regard hepatitis B antigenemia (HBsAg+) as a contraindication to renal transplantation. We studied the records of 13,287 renal transplant recipients, 781 (5.88%) who were positive for HBsAg, the remainder negative (HBsAg-). Patient survival for HBsAg-recipients is 91.8% at 1 year, 80.6% at 5 years, and 65.8% at 10 years. Patient survival for HBsAg+ recipients was 88.8% at 1 year, 77.6% at 5 years, and 61.6% at 10 years. The difference in patient survival was 3-4%, and graft survival was nearly constant at 3%. The statistical significance for patient survival was p = 0.02 by the log-rank test and p = 0.007 by the Wilcoxon test. There is far more statistical power (p = 0.0001) in other risk factors such as transplant number, recipient race, recipient age, and diabetes. Currently available diagnostic studies may allow better risk stratification of HBsAg+ candidates. We believe that hepatitis antigenemia without added and related risk factors has only a mild effect on graft and patient outcome.