Background Hepatitis B virus(HBV) infection is common among uremia patients in China. Many patients received kidney transplantation are occult HBV carriers with HBsAg(-) and HBcAb(+) . The aim of this study is to investigate whether it is necessary to use prophylactic anti-virus therapy for occult HBV carriers after kidney transplantation.

Methods We retrospectively analyzed 398 occult HBV carriers who received kidney transplantation in our hospital from January 2000 to December 2010. All patients had HBsAg(-), HBcAb(+), and HBV-DNA negative before transplant. HBsAg and HBV-DNA were routinely checked for diagnosis of HBV reactivation. The patients were divided into prophylactic group and control group according to whether or not they received prophylactic anti-HBV therapy with lamivudine. Prophylactic group had 112 patients and control group had 286 patients.

Results 3 (2.7%) patients had HBV reactivation after kidney transplant in prophylactic group, compared to 15(5.2%) patients in control group(p=0.268). Liver function impairment occurred in 25(22.3%) recipients in prophylactic group, while occurred in 84(29.4%) in control group(p=0.156). The incidences of hepatic failure and hepatic carcinoma were both comparable between two groups. The 1-,5-, and 10-year graft survival and patient survival were also comparable. Logistic multivariate analysis showed that acute rejection and old age(>60 years) were independent risk factors for HBV reactivation(p<0.05). In subgroup analysis, we select the high risk patients with acute rejection or age more than 60 years, 35(31.3%) cases in prophylactic group and 86(30.1%) cases in control group. The results showed that in high risk patients, prophylactic anti-virus therapy could significantly decreased the HBV reactivation rate compared with control group(2.9% and 16.3% respectively, p=0.023). In addition, incidence of liver function impairment was also significantly lower in prophylactic group(22.9% and 48.8%, respectively, p=0.009). Hepatic failure, graft and patient survival were all comparable between the two groups(p>0.05).

Conclusions Prophylactic anti-virus therapy is not necessary in most of occult HBV carriers after kidney transplantation, and may only help in high risk patients with old age or acute rejection.

CITATION INFORMATION: Chen G, Wang C, Chen L, Qiu J, Wang C. Prophylactic Anti-Virus Therapy, Is It Necessary to Occult Hepatitis B Virus Carriers with HBsAg(-) and HBcAb(+) After Kidney Transplantation? Am J Transplant. 2016;16 (suppl 3).

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