Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Background: Hepatitis B virus (HBV) reactivation is a well-known complication of immunosuppressive therapy in resolved HBV (hepatitis B surface antigen [HBsAg] negative and hepatitis B core antibody [anti-HBc] positive) patients. Although increasing use of rituximab in kidney transplantation, the risk of HBV reactivation after kidney transplantation remains undetermined.
Methods: We analyzed 199 resolved HBV patients who underwent living donor kidney transplantation between 2008 and 2014. The patients were divided into rituximab group (n=61) and control group (n=138). All patients were observed for HBV reactivation, which was defined as HBsAg seroreversion. No patients received prophylactic antiviral agents. Entecavir was started for the patients since HBV reactivation.
Results: During the follow-up period, five patients (8.2%) in rituximab group and two patients (1.4%) in control group developed HBV reactivation (p=0.007). All patients showed serum HBV DNA level of more than 7 log 10 IU/mL. In rituximab group, 4 patients experienced HBV-related hepatitis flare (serum alanine aminotransferase more than 100 IU/L), including one patient who died of hepatic failure. The median time from the rituximab treatment to HBV reactivation was 11 months (range, 5 – 22). In contrast, one patient experienced hepatitis flare in control group. Use of rituximab (hazard ratio, 7.84; 95% CI, 1.50 to 40.00; p= 0.015) and hepatitis B surface antibody status (hazard ratio, 4.97; 95% CI, 1.11 to 22.34, p=0.037) were the significant risk factors for the HBV reactivation.
Conclusion: Rituximab significantly increased the risk of HBV reactivation in resolved HBV patients after kidney transplantation. Close monitoring and prophylaxis strategies are required in these patients.
CITATION INFORMATION: Lee J, Park J, Lee J, Song S, Lee J, Kwon S.-K, Huh K, Kim B, Kim M, Kim S, Ahn S, Kim Y. The Effect of Rituximab on Hepatitis B Reactivation in Kidney Transplant Recipients with Resolved Hepatitis B. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Lee J, Park J, Lee J, Song S, Lee J, Kwon S-K, Huh K, Kim B, Kim M, Kim S, Ahn S, Kim Y. The Effect of Rituximab on Hepatitis B Reactivation in Kidney Transplant Recipients with Resolved Hepatitis B. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/the-effect-of-rituximab-on-hepatitis-b-reactivation-in-kidney-transplant-recipients-with-resolved-hepatitis-b/. Accessed May 21, 2019.
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