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Nephrol Dial Transplant. 2017 Apr 1;32(4):722-729. doi: 10.1093/ndt/gfw455.

Rituximab and hepatitis B reactivation in HBsAg-negative/ anti-HBc-positive kidney transplant recipients.

Lee J1,2, Park JY3,4, Huh KH1,2,5, Kim BS4,5,6, Kim MS1,2,5, Kim SI1,2,5, Ahn SH3,4, Kim YS1,2,5.

Author information

1
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
2
Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Gastroenterology, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
4
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
5
The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
6
Department of Nephrology, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.

Abstract

Background:

Hepatitis B virus (HBV) reactivation is a well-known complication of immunosuppressive therapy. Although rituximab is increasingly used for desensitization of ABO-incompatible or positive crossmatch kidney transplantation, the risk of HBV reactivation in hepatitis B surface antigen (HBsAg)-negative/hepatitis B core antibody (anti-HBc)-positive kidney transplant patients receiving rituximab desensitization remains undetermined.

Methods:

We analysed 172 resolved HBV patients who underwent living donor kidney transplantation between 2008 and 2014. Patients were divided into rituximab ( n  =  49) or control ( n  =  123) groups. All patients were observed for HBV reactivation, which was defined as the reappearance of hepatitis B surface antigen or HBV DNA.

Results:

During the follow-up period (median, 58 months; range, 4-95 months), five patients (10.2%) in the rituximab group and two patients (1.6%) in the control group experienced HBV reactivation (P   =   0.003). In the rituximab group, two patients experienced HBV-related severe hepatitis, and one patient died due to hepatic failure. The median time from rituximab desensitization to HBV reactivation was 11 months (range, 5-22 months). By contrast, no patients in the control group experienced severe hepatitis. The status of hepatitis B surface antibody was similar between groups. Rituximab desensitization [hazard ratio (HR), 9.18; 95% confidence interval (CI), 1.74-48.86; P   =   0.009] and hepatitis B surface antibody status (HR, 4.74; 95% CI, 1.05-21.23, P =   0.04) were significant risk factors for HBV reactivation.

Conclusions:

Rituximab desensitization for incompatible kidney transplantation significantly increased the risk of HBV reactivation in HBsAg-negative/anti-HBc-positive patients. Therefore, close monitoring of HBV DNA is required in these patients.

KEYWORDS:

hepatitis B virus; immunosuppression; kidney transplantation; reactivation; rituximab

PMID:
28339910
DOI:
10.1093/ndt/gfw455
[Indexed for MEDLINE]

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