*Purpose: Because of the low prevalence of Hepatitis Surface Antigen (HBsAg)-positive patients, only a few reports have evaluated the actual outcome of these patients after kidney transplant. This study aimed to provide real-world outcome of HBsAg-positive patients after transplant.

*Methods: HBsAg-positive patients who underwent kidney transplant between January, 1999 and December, 2018 at a single institution were enrolled retrospectively. Outcomes including HBV reactivation rate, risk factor for HBV reactivation, patient survival and graft survival were analyzed. Patient and graft survival of HBsAg positive patients were compared that of propensity score matched HBsAg negative patients.

*Results: A total of 77 patients were enrolled and mean ± sd age was 47.1 ± 11.5 years. Patients received ABOi (n = 5), crossmatch positive transplant (n = 4), and re-transplant (n = 4). Three (3.9%) patients received rabbit anti-thymocyte globulin and 10 (13.0%) patients received rituximab. Forty-six (59.7%) patients received prophylactic, 19 (24.7%) patient received medication at least 3 months before transplant and 12 (15.6%) patients did not receive medication. Seventeen (23.0%) out of 74 patients developed HBV reactivation after transplant. Not taking antiviral agents at the time of transplant tended to increase the risk HBV reactivation (HR = 2.602, 95% CI: 0.956-7.081, P = 0.061). There was no significant difference in patient survival between HBsAg positive patients who received antiviral agent and HBs Ag- patients.

*Conclusions: HBsAg positivity in kidney transplant recipients is associated with substantial HBV reactivation rate. Not taking antiviral medication at the time of transplant tend to increase risk for HBV reactivation.

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