Hepatitis B virus infection in renal transplant recipients
- Tak-Mao Chan, MD, FRCP
Tak-Mao Chan, MD, FRCP
- Chair Professor & Yu Chiu Kwong Endowed Professor in Medicine
- University of Hong Kong
- Anna SF Lok, MD
Anna SF Lok, MD
- Professor of Medicine
- University of Michigan Medical School
- Section Editors
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Johns Hopkins Medical School
- Medical Director and Co-Director of The Comprehensive Transplant Center
- Department of Internal Medicine
- Division of Nephrology
- Barbara Murphy, MB, BAO, BCh, FRCPI
Barbara Murphy, MB, BAO, BCh, FRCPI
- Section Editor — Renal Transplantation
- Professor of Medicine
- Mount Sinai School of Medicine
Hepatitis B virus (HBV) infection is a major risk factor for hepatic dysfunction after renal transplantation  because of the requirement for immunosuppressive therapies . Although the incidence of HBV infection has declined among dialysis patients, the prevalence is still high in endemic areas.
This topic reviews the prognosis and management of HBV in end-stage renal disease (ESRD) patients who are undergoing renal transplantation. The serologic diagnosis of HBV infection and a general overview of management are provided elsewhere. (See "Diagnosis of hepatitis B virus infection" and "Hepatitis B virus: Overview of management".)
EPIDEMIOLOGY AND RISK FACTORS
Incidence and prevalence — In endemic areas, a significant number of patients undergoing kidney transplantation are hepatitis B surface antigen (HBsAg) positive. The reported prevalence is approximately 15 percent of kidney transplant recipients in such locations . The prevalence is much lower in areas in which HBV is less common.
Overall, the prevalence appears to be declining in most countries as a result of HBV vaccination programs in the general and dialysis patient population, as well as the result of strict precautions to prevent transmission of HBV infection in dialysis units. A national surveillance in the United States in 2002, for example, revealed that only 1 percent of dialysis patients was seropositive for HBsAg . (See "Hepatitis B virus and dialysis patients".)
Risk factors for reactivation of HBV replication — Among HBsAg-positive patients, reactivation of HBV replication is variably defined by the appearance of HBV DNA in a patient who has had undetectable HBV DNA previously or by a >1 to 2 log increase in HBV DNA. Among HBsAg-negative, hepatitis B core antibody (anti-HBc)-positive patients, reactivation is defined by the reappearance of HBsAg or HBV DNA or an increase in HBV DNA in those with detectable HBV DNA prior to the start of immunosuppressive therapy.
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- EPIDEMIOLOGY AND RISK FACTORS
- Incidence and prevalence
- Risk factors for reactivation of HBV replication
- Risk factors for liver failure among infected patients
- Risk factors for de novo HBV infection following transplantation
- EVALUATION PRIOR TO TRANSPLANTATION
- PREVENTION OF REACTIVATION OF HBV REPLICATION AFTER TRANSPLANTATION
- HBsAg-positive patients
- - Antiviral therapy
- - Reduction of immunosuppression
- HBsAg-negative, anti-HBc-positive patients
- MONITORING AFTER TRANSPLANTATION
- APPROACH TO PATIENTS WHO HAVE REACTIVATION OF HBV REPLICATION AFTER TRANSPLANTATION
- Antiviral agents
- - Entecavir, telbivudine, and tenofovir
- - Lamivudine
- - Adefovir
- - Interferon
- SUMMARY AND RECOMMENDATIONS