Hepatitis B Reactivation After Kidney Transplantation in Hepatitis B Surface Antigen-Positive Recipients
Experimental and Clinical Transplantation, cilt.24, sa.6, ss.352-355, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 24 Sayı: 6
- Basım Tarihi: 2026
- Doi Numarası: 10.6002/ect.mesot2025.p148
- Dergi Adı: Experimental and Clinical Transplantation
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO)
- Sayfa Sayıları: ss.352-355
- Anahtar Kelimeler: Antiviral prophylaxis, Immunosuppressive treatment, Renal transplant, Viral hepatitis
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objectives: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.