Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients
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Data
2014-12-01
Autores
Emori, Christini Takemi [UNIFESP]
Perez, Renata de Mello [UNIFESP]
Matos, Carla Adriana Loureiro de [UNIFESP]
Uehara, Silvia Naomi de Oliveira [UNIFESP]
Pereira, Patrícia da Silva Fucuta [UNIFESP]
Feldner, Ana Cristina de Castro Amaral [UNIFESP]
Carvalho-Filho, Roberto José de [UNIFESP]
Souza e Silva, Ivonete Sandra de [UNIFESP]
Silva, Antonio Eduardo Benedito [UNIFESP]
Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]
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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.
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Brazilian Journal of Infectious Diseases. Brazilian Society of Infectious Diseases, v. 18, n. 6, p. 625-630, 2014.