Incidence of Hepatitis B Virus Reactivation in Kidney Transplant Patients Who Received Rituximab Administration
K. Omoto, M. Okumi, D. Toki, T. Shimizu, H. Ishida, K. Tanabe.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Meeting: 2015 American Transplant Congress
Abstract number: D274
Keywords: Hepatitis B, Immunosuppression, Kidney transplantation, Reinfection
Session Information
Session Name: Poster Session D: Viral Infections
Session Type: Poster Session
Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
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.
To cite this abstract in AMA style:
Omoto K, Okumi M, Toki D, Shimizu T, Ishida H, Tanabe K. Incidence of Hepatitis B Virus Reactivation in Kidney Transplant Patients Who Received Rituximab Administration [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-of-hepatitis-b-virus-reactivation-in-kidney-transplant-patients-who-received-rituximab-administration/. Accessed October 15, 2024.« Back to 2015 American Transplant Congress