In our study we investigated the outcome (graft failure and or death) in renal allograft recipients with hepatitis B.

We performed a retrospective analysis of all patients (pts) after kidney-only transplantation (Tx) in our database. All patients had information about their HBsAg and anti-HBc status. The rate of patient survival, death-censored and overall graft survival was analyzed for 3 groups (1: HBsAg negative and anti-HBc negative, 2: HBsAg negative and anti-HBc positive and 3: HBsAg positive). In addition we looked at the outcome in HBsAg positive pts depending on hepatitis B specific therapy.

In 1143 renal transplanted patients (61.3% male, age 48.7 ± 14.7 (mean ± SD)) we had complete information about Hepatitis B status and outcome. 966 pts (84.5%) were HBsAg and anti-HBc negative, 109 pts (9.5%) were HBsAg negative and anti-HBc positive, and 68 pts (5.9%) were HBsAg positive. 21 pts of group 3 received therapy against hepatitis B (30.9%). Lamivudine was used alone (N=13), in combination with tenofovir (N=2) or adefovir (N=1). Other monotherapeutic regimens included Entecavir (N=4) or adefovir (N=1).

In total, 237 pts (20.7%) died and 135 graft failures (11.8%) occurred during the observation period resulting in a patient survival of 74.8%, death censored graft survival of 84.4 % and overall graft survival of 69.2% after 10 years. 10-year patient survival differed significantly (p=0.03) according to the hepatitis B status at transplantation: 76.6% (group 1), 63.3% (group 2) and 69.9% (group 3), respectively. Death censored graft survival was similar between groups. The combined 10-year patient and graft survival showed a significant (p=0.033) difference: 70.5% (group 1), 58.1% (group 2) and 63.6% (group 3) after 10-years. Hepatitis B positive patients who received treatment had similar patient and graft survival compared to pts not receiving treatment.

The previous exposure to Hepatitis B, even for patients with no active viral replication has a negative impact on patient survival after renal transplantation.This present analysis demonstrates clearly, that HepB infection has a negative impact on patient survival in contrast to not infected renal transplant patients. Noticeable, already pre transplant recovered and cured, sero-negative HepB patients having inferior outcome with a higher mortality after transplantation. Thus, cured HepB patients have a comparable mortality risk to active HepB patients and need adequate safety monitoring to prevent adverse events in this imperilled patients group.

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