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Title: Factors associated with the intensity of liver fibrosis in renal transplant patients with hepatitis B virus infection
Authors: Matos, Carla Adriana Loureiro de [UNIFESP]
Perez, Renata de Mello [UNIFESP]
Lemos, Lara Barros [UNIFESP]
Pestana, Jose Osmar Medina [UNIFESP]
Lanzoni, Valeria Pereira [UNIFESP]
Albertoe, Fernando L.
Moreira, Eloisa S.
Silva, Antonio Eduardo Benedito [UNIFESP]
Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Fleury Med Diagnost Ctr
Keywords: fibrosis
hepatitis B
hepatitis B virus-DNA
hepatitis C
kidney transplantation
liver biopsy
Issue Date: 1-Aug-2007
Publisher: Lippincott Williams & Wilkins
Citation: European Journal Of Gastroenterology & Hepatology. Philadelphia: Lippincott Williams & Wilkins, v. 19, n. 8, p. 653-657, 2007.
Abstract: Background Hepatitis B may show a more aggressive course after kidney transplantation, but the factors associated with the progression of fibrosis in this group have not been identified.Objectives To determine the influence of hepatitis B virus (HBV) viral load and host-related factors on the progression of hepatic fibrosis in hepatitis B virus-infected renal transplant recipients.Patients and methods Renal transplant patients positive for HBV surface antigen (HBsAg) and submitted to a liver biopsy because of evidence of viral replication were included. Patients with advanced fibrosis (METAVIR F3-F4) were compared with patients with mild fibrosis (F0-F2) regarding sex, age, estimated time since infection, post-transplant time, donor type, history of renal transplantation, alanine aminotransferase, anti-hepatitis C virus, HBeAg and quantitative hepatitis B virus-DNA. Logistic regression analysis was applied to identify variables independently associated with more advanced fibrosis.Results Fifty-five patients (75% men, 41 +/- 11 years) with a mean post-transplant time of 5 +/- 4 years were included. HBeAg was detected in 67% of the patients and anti-hepatitis C virus in 35%. The median hepatitis B virus-DNA level was 2.8 x 10(8) copies/ml. Seventeen (31%) patients had advanced fibrosis. Using logistic regression analysis, the only variable that showed an independent association with more advanced stages of fibrosis was post-transplant time (P=0.03, odds ratio: 1.2, 95% confidence interval: 1.02-1.45).Conclusion Hepatitis B virus viral load, although very high, and hepatitis B virus/hepatitis C virus coinfection are not related to the intensity of liver fibrosis in renal transplant patients infected with hepatitis B virus. Post-transplant time was the only factor independently associated with more advanced liver fibrosis, suggesting the influence of immunosuppression on the progression of liver disease in these patients.
ISSN: 0954-691X
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