Impact of antiviral treatment on long-term survival of kidney transplant recipients with hepatitis B virus infection

[[abstract]]Background: Long-term survival of kidney transplant recipients (KTRs) remains an important issue. Reactivation of HBV may occur in the KTRs with HBV infection after kidney transplantation because of immunosuppressive therapy. The presentations of HBV reactivation may involve hepatitis, hepatic failure or death. However, it is controversial whether a KTR with HBV seropositivity should receive immediate prophylactic therapy after kidney transplantation. This study aimed to investigate the impact of preemptive HBV treatment on the survival of the KTRs with HBV infection. Methods: Between January 2001 and March 2010, 110 HBsAg seropositive KTRs in a single center in central Taiwan were enrolled in this retrospective study. The patients were subdivided into two groups including one with HBV flare-up and receiving oral antiviral therapy, the other one was with neither HBV flare-up nor treatment. HBV flare-up was defined as an increase in serum alanine aminotransferase (ALT) level more than upper limit of normal range. All data were analyzed with the SPSS14.0 package software. Results: Of the 110 patients, elevated serum ALT levels developed in 42 patients (38.2 percent) who were considered to be with HBV reactivation and oral antiviral treatment was given while 68 patients (61.8 percent) were without HBV flare-up. The risks for mortality included hypertension (p=0.048) and the primary cause of dialysis (p=0.038). The patient survival was not associated with age, gender, HLA mismatches, duration or modality of dialysis prior to kidney transplantation, diabetes mellitus, hyperlipidemia or acute rejection. The patient survival was comparable between the two groups (Log rank test, p= 0.487). Conclusion: The KTRs with HBV reactivation receiving preemptive HBV therapy were with comparable patient survival with those without HBV flare-up