Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

作者：Emori Christini Takemi^*; Perez Renata Melo; Loureiro de Matos Carla Adriana; Oliveira Uehara Silvia Naomi; Fucuta Pereira Patricia da Silva; Amaral Feldner Ana Cristina; de Carvalho Filho Roberto Jose; de Souza e Silva Ivonete Sandra; Benedito Silva Antonio Eduardo; Gomes Ferraz Maria Lucia

来源：Brazilian Journal of Infectious Diseases, 2014, 18(6): 625-630.

DOI：10.1016/j.bjid.2014.06.004

• Renal transplantation
• Hepatitis B
• ALT flare
• Lamivudine

Introduction: There is scarce information regarding clinical evolution of HBV infection in renal transplant patients. %26lt;br%26gt;Aims: To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis. %26lt;br%26gt;Materials and methods: HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT %26gt;5 x ULN and/or %26gt;3x baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis. %26lt;br%26gt;Results: 140 HBV-infected renal transplant patients were included (71% males; age 46 10 years; post-renal transplant time 8 5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4 3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect. %26lt;br%26gt;Conclusions: Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.

• 出版日期2014-12