Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

Author Emori, Christini Takemi Autor UNIFESP Google Scholar
Perez, Renata de Mello Autor UNIFESP Google Scholar
Matos, Carla Adriana Loureiro de Autor UNIFESP Google Scholar
Uehara, Silvia Naomi de Oliveira Autor UNIFESP Google Scholar
Pereira, Patrícia da Silva Fucuta Autor UNIFESP Google Scholar
Feldner, Ana Cristina de Castro Amaral Autor UNIFESP Google Scholar
Carvalho-Filho, Roberto José de Autor UNIFESP Google Scholar
Souza e Silva, Ivonete Sandra de Autor UNIFESP Google Scholar
Silva, Antonio Eduardo Benedito Autor UNIFESP Google Scholar
Ferraz, Maria Lucia Cardoso Gomes Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Universidade Federal do Rio de Janeiro (UFRJ) Internal Medicine Department
Abstract Introduction: There is scarce information regarding clinical evolution of HBV infection in renal transplant patients. Aims: To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis. Materials and methods: HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5 × ULN and/or >3 × baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis. Results: 140 HBV-infected renal transplant patients were included (71% males; age 46 ±10 years; post-renal transplant time 8 ±5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4 ±3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect. Conclusions: Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.
Keywords Renal transplantation
Hepatitis B
ALT flare
Language English
Date 2014-12-01
Published in Brazilian Journal of Infectious Diseases. Brazilian Society of Infectious Diseases, v. 18, n. 6, p. 625-630, 2014.
ISSN 1413-8670 (Sherpa/Romeo, impact factor)
Publisher Brazilian Society of Infectious Diseases
Extent 625-630
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000346072500006
SciELO ID S1413-86702014000600625 (statistics in SciELO)

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