Backgrounds: Hepatitis B surface antigen (HBsAg)-positive kidney recipients are at increased risk for mortality and graft failure compared with HBsAg-negative recipients. The aims of this study were to identify the outcomes of HBsAg-positive recipients who received preemptive antiviral agents after successful kidney transplantation and to analyze risk factors for HBV reactivation.

Methods: We retrospectively reviewed the medical records of 944 patients performed kidney transplantation between 1999 and 2010. HBsAg-positive recipients received antiviral agents after transplantation.

Results: HBsAg-negative recipients were 902 patients and HBsAg-positive recipients, 42. Among HBsAg-positive recipients, thirty-five of these patients received lamivudine, 6 received entecavir and one received adefovir. HBV reactivation was detected in 7 patients, and 12 patients among 35 patients who received lamivudine showed lamivudine resistance. All patients were under treatment with antiviral agents at the time of last assessment. Among these patients, only one was taking adefovir and lamivudine combination therapy and the others were on monotherapy (24 patients with lamivudine, 5 with adefovir, and 12 with entecavir). At the end of follow-up, HBV reactivation was well controlled by switch or combination therapy in all patients with the disease. Graft failure developed in only one patient due to chronic rejection regardless of HBV reactivation but no deaths occurred. All patients were alive at the end of follow-up and none developed end-stage liver disease or hepatocellular carcinoma. There was statistically significant difference in graft survival between HBsAg-positive recipients and HBsAg-negative. Multivariate analysis identified increased HBV DNA levels (>5×10⁴ IU/mL) in the HBsAg-positive prospective kidney recipient as a risk factor for HBV reactivation (P=0.007).

Conclusion: Effective viral suppression with antiviral agents in HBsAg-positive renal transplant recipients improves patient outcome and allograft survival. Antiviral therapy may be especially beneficial in patients with high HBV DNA levels prior to transplantation.

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