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

• Autor(a) principal: Emori, Christini Takemi [UNIFESP]
• Data de Publicação: 2014
• Outros Autores: 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]
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNIFESP
• dARK ID: ark:/48912/001300001bmq2
• DOI: 10.1016/j.bjid.2014.06.004
• Texto Completo: http://dx.doi.org/10.1016/j.bjid.2014.06.004; http://repositorio.unifesp.br/handle/11600/8685
• topic: Renal transplantation; Hepatitis B; ALT flare; Lamivudine

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.