OBJECTIVE:

The efficacy of antiviral prophylaxis for rituximab (RIT)-associated hepatitis B virus (HBV) reactivation in patients with lymphoma has been recently reported. However, the immunological effect of single-dose RIT in relation to HBV reactivation in kidney transplant patients with hepatitis B surface antigen-negative (HBsAg−) and hepatitis B core antigen antibody-positive (HBcAb+) results is still unclear. Moreover, there is no evidence that prophylaxis is necessary in HBsAg−/HBcAb+ patients who received single-dose RIT. To assess the incidence of RIT-associated HBV reactivation after kidney transplantation (KTx), we investigated the outcome of KTx in HBsAg−/HBcAb+ patients who received RIT therapy.

METHODS:

Between 2001 and 2013, 770 patients underwent KTx at our institute, of whom 38 (4.9%) had HBsAg−/HBcAb+ results. A RIT dose of 200 mg/body was administered to 31 patients before KTx. Furthermore, all of the HBsAg−/HBcAb+ patients were hepatitis C virus (HCV)-RNA-negative, hepatitis B surface antibody-positive (HBsAb+), and HBV-DNA-negative. Twenty-eight of the 31 patients did not receive any antiviral prophylaxis. We monitored HBV-DNA and alanine transaminase (ALT) levels every 1 to 3 months after KTx. HBV reactivation was defined as an elevation of serum HBV-DNA level ≥2.1 log copies/mL.

RESULTS:

RIT-associated HBV reactivation was found in 3.6% (1/28) of the HBsAg−/HBcAb+ patients without prophylaxis. Two (7.2%) of the 28 patients had acute graft rejection. In the patient with HBV reactivation, HBV-DNA expression was detected at 6 weeks after KTx, and the minimum and maximum serum HBV-DNA levels were 2.1 and 2.6 log copies/mL, respectively. The patient had a maximum serum ALT level of 49 U/L and showed no acute graft rejection. Although the patient was not treated with specific antiviral therapy after HBV reactivation, the HBV-DNA expression serologically disappeared at 8 months after KTx. HBV reactivation was not found in the HBsAg−/HBcAb+ patients who did not receive RIT and in the 3 patients who received lamivudine prophylaxis during the observation period.

CONCLUSIONS:

The incidence of RIT-associated HBV reactivation in the HBsAg−/HBcAb+ patients who did not receive antiviral prophylaxis was less than 5%. Although the low incidence of RIT-associated HBV reactivation may be associated with the administration of low-dose RIT, sequential monitoring of HBV-DNA levels is needed to avoid severe HBV reactivation.

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