Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation · 2026
Hepatitis B Reactivation After Kidney Transplantation in Hepatitis B Surface Antigen-Positive Recipients.
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Tatar Bengü, Uslu Adam, Arı Alpay, Kavak Selçuk, Altıngöz Esra, Okut Gökalp, Tatar Erhan
Аннотация
OBJECTIVES: Hepatitis B virus reactivation in HBsAg -positive kidney transplant recipients sometimes results in liver failure and death. Although current guidelines recommend continuing antiviral therapy for ≥6 months after the last dose of immunosuppressive therapy, in transplant recipients, duration is uncertain because immunosuppressive therapy is lifelong. Here, we evaluated the incidence and effects of hepatitis B virus reactivation in kidney transplant recipients with hepatitis B virus infection.
MATERIALS AND METHODS: We reviewed patients who underwent kidney transplant between 2012 and 2023; we excluded patients with missing hepatitis B serology, those who were hepatitis B surface antigen negative /anti -HBc negative, those with total follow -up of <1 year, and those with coinfection. Hepatitis B virus reactivation was defined as at least a 100 -fold increase in hepatis B virus DNA levels in patients with previously detectable or levels that were negative before becoming positive.
RESULTS: In 21 hepatitis B surface antigen -positive kidney transplant recipients, mean age was 45.8 ± 8.5 years, 76 % were male, and 62 % had living donor transplant. Mean follow -up was 86 ± 32 months. Seven transplant recipients received antiviral treatment (3 with entecavir, 3 with tenofovir disoproxil fumarate, 1 with lamivudine ). Among 14 patients without antiviral treatment, 7 had positive HBV DNA ( >69 IU /mL ) at time of transplant All recipients received prophylactic antiviral therapy (14 received entecavir, 4 received lamivudine, 3 received tenofovir disoproxil fumarate ) concomitant with transplant. During follow -up, hepatitis B virus reactivation was observed in 25 % of patients who received lamivudine. No serious adverse outcomes, including liver transplant or death, due to HBV reactivation were observed.
CONCLUSIONS: Although optimal duration of prophylactic antiviral therapy remains unclear, entecavir or tenofovir was the preferred antiviral therapy over lamivudine for hepatitis B virus reactivation prophylaxis. Close monitoring with antiviral prophylaxis is the optimal strategy to prevent hepatitis B virus reactivation during immunosuppressive therapy.
MATERIALS AND METHODS: We reviewed patients who underwent kidney transplant between 2012 and 2023; we excluded patients with missing hepatitis B serology, those who were hepatitis B surface antigen negative /anti -HBc negative, those with total follow -up of <1 year, and those with coinfection. Hepatitis B virus reactivation was defined as at least a 100 -fold increase in hepatis B virus DNA levels in patients with previously detectable or levels that were negative before becoming positive.
RESULTS: In 21 hepatitis B surface antigen -positive kidney transplant recipients, mean age was 45.8 ± 8.5 years, 76 % were male, and 62 % had living donor transplant. Mean follow -up was 86 ± 32 months. Seven transplant recipients received antiviral treatment (3 with entecavir, 3 with tenofovir disoproxil fumarate, 1 with lamivudine ). Among 14 patients without antiviral treatment, 7 had positive HBV DNA ( >69 IU /mL ) at time of transplant All recipients received prophylactic antiviral therapy (14 received entecavir, 4 received lamivudine, 3 received tenofovir disoproxil fumarate ) concomitant with transplant. During follow -up, hepatitis B virus reactivation was observed in 25 % of patients who received lamivudine. No serious adverse outcomes, including liver transplant or death, due to HBV reactivation were observed.
CONCLUSIONS: Although optimal duration of prophylactic antiviral therapy remains unclear, entecavir or tenofovir was the preferred antiviral therapy over lamivudine for hepatitis B virus reactivation prophylaxis. Close monitoring with antiviral prophylaxis is the optimal strategy to prevent hepatitis B virus reactivation during immunosuppressive therapy.