Abstract
Background and Aims
Dialysis patients (pts) have an increased risk for hepatitis B (HB) infection and impaired response to HB vaccine compared to the general population. As shown in other studies, patient and graft survival in pts with chronic HB is worse. This study assesses the outcome of HBc-positive patients after kidney transplantation (KTx).
Method
In our retrospective analysis we included all patients >18 years old, who underwent kidney transplantation from 01.01.1990 to 31.08.2019 in our center. Patients were grouped by their serostatus prior to kidney transplantation into “A: naïve” (HB negative), “B: HBc-positive” (non-active HB) and “C: HBsAg-positive” (chronic HB). Primary endpoints included patient and graft survival analyzed with Kaplan-Meier and log-rank test. Regression analysis was applied to determine independent risk factors for the occurrence of primary endpoints.
Results
In 2487 kidney transplant patients, serologic markers were retrievable. We identified n=2198 HB naïve, n=218 non-active HB and n=75 chronic HB pts. Overall 29.1% (A:27.7%, B:37.6%, C:45.3%) pts died and 20.3% (A:19.1%, B:27.5%, C:37.3%) pts suffered from graft failure. The 5-year pts survival (Fig. 1) was A: 87.0%, B: 82.8%, C: 82.2%. The 10-year pts survival was A: 71.7%, B: 61.1%, C: 64.5% and the 20-year pts survival was A: 43.1%, B: 26.1%, C: 40.9% (p=0.01). Kaplan-Meier-analysis showed a 5-year graft survival (Fig. 2) of 87.7% in the naïve, 86.1% in non-active HB and 84.3% in chronic HB group. The 10-year graft survival was A: 77.3%, B: 64.9%, C: 76% and the 20-year graft survival was A: 59.7%, B: 52.2%, C: 33.4% (p<0.001). The overall 5-year pts and graft survival (Fig. 3) was A: 78.7%, B: 74.2%, C: 68.6%. The 10-year pts and graft survival was A: 59.8%, B: 46.4%, C: 51.8%. The 20-year overall rate was A: 30.8%, B: 26.4%, C: 14.9% (p<0.001).
Regression analysis (Table 1) showed that anti-HBs positivity (≥100 IE/l) was a protective factor for graft failure and death (p<0.001).
Conclusion
HB leads to earlier graft loss and inferior patient survival. Beside the already known negative effect of chronic HB infection, also in patients with non-active HB infection overall survival was significant worse to HB naïve patients. Thus, non-active HB status is an important risk factor for overall transplant outcome. Next, influence of antiviral and immunosuppressive regimens and incidence of HB-reactivation are to be analyzed.
Control of replication of hepatitis B and C virus improves patient and graft survival in kidney transplantation