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2017 ; 9
(25
): 1054-1063
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Hepatitis B in renal transplant patients
#MMPMID28951777
Marinaki S
; Kolovou K
; Sakellariou S
; Boletis JN
; Delladetsima IK
World J Hepatol
2017[Sep]; 9
(25
): 1054-1063
PMID28951777
show ga
Hepatitis B virus (HBV) poses a significant challenge for both dialysis patients
and kidney transplant recipients despite its decreasing rates, especially in
developed countries. The best preventive method is vaccination. Patients with
chronic renal disease should ideally be vaccinated prior to dialysis, otherwise,
reinforced vaccination practices and close antibody titer monitoring should be
applied while on dialysis. HBV infected dialysis patients who are renal
transplant candidates must be thoroughly examined by HBV-DNA, and liver enzyme
testing and by liver biopsy. When needed, one must consider treating patients
with tenofovir or entecavir rather than lamivudine. Depending on the cirrhosis
stage, dialysis patients are eligible transplant recipients for either a combined
kidney-liver procedure in the case of decompensated cirrhosis or a lone kidney
transplantation since even compensated cirrhosis after sustained viral responders
is no longer considered an absolute contraindication. Nucleoside analogues have
led to improved transplantation outcomes with both long-term patient and graft
survival rates nearing those of HBsAg(-) recipients. Moreover, in the cases of
immunized HBsAg(-) potential recipients with concurrent prophylaxis, we are
enabled today to safely use renal grafts from both HBsAg(+) and
HBsAg(-)/anti-HBc(+) donors. In so doing, we avoid unnecessary organ discarding.
Universal prophylaxis with entecavir is recommended in HBV kidney recipients and
should start perioperatively. One of the most important issues in HBV(+) kidney
transplantation is the duration of antiviral prophylaxis. In the absence of
robust data, it seems that prophylactic treatment may be discontinued in selected
stable, low-risk recipients during maintenance immunosuppression and should be
reintroduced when the immune status is altered. All immunosuppressive agents in
kidney transplantation can be used in HBV(+) recipients. Immunosuppression is
intimately associated with increased viral replication; thus it is important to
minimize the total immunosuppression burden long term.
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