© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Transplant Infectious Disease, ISSN 1398-2273
Effects of hepatitis B surface antigen (HBsAg) positivity of donors in HBsAg(+) renal transplant recipients: comparison of outcomes with HBsAg(+) and HBsAg( ) donors _ Aliosmanoglu, H. Erbis, B.V. Ulger, R. Cetinkaya, G. V.T. Yilmaz, I. Suleymanlar, H. Kocak. Effects of hepatitis B surface antigen (HBsAg) positivity of donors in HBsAg(+) renal transplant recipients: comparison of outcomes with HBsAg(+) and HBsAg( ) donors. Transpl Infect Dis 2016: 18: 55–62. All rights reserved Abstract: Aim. The aim of this study was to determine the effects of hepatitis B surface antigen (HBsAg) positivity of the donors on graft survival and liver complications in HBsAg(+) renal transplant recipients. Patients and method. A group of 55 patients who underwent renal transplantation (RTx) in our hospital between 2001 and 2012 were included in the study. Patients were divided into 2 groups. Group 1 (n = 50) consisted of HBsAg(+) renal transplant recipients (RTR) whose donors were HBsAg( ). In Group 2 (n = 5), RTR and donors were both HBsAg(+). Lymphocyte cross matches, number of mismatches, donor types, renal replacement treatment modalities, drugs of induction treatment, and preoperative hepatitis B virus DNA titers of the groups were similar. In Group 1, 42 patients were taking lamivudine, 3 patients were taking entecavir, and 5 patients were taking tenofovir. All of the patients in Group 2 were taking lamivudine. Patient and graft survival rates, graft functions, acute hepatitis rates, acute rejection rates, and other clinical outcomes of the groups were compared. Results. Demographic data of the groups were similar. Acute rejection rates (P = 0.458), graft survival rates (P = 0.515), and patient survival rates (P = 0.803) were also similar. No significant difference was found between the groups in terms of acute hepatitis rate (P = 0.511), glomerular filtration rate (calculated by Modification of Diet in Renal Disease formula) in the last follow-up (P = 0.988), alanine aminotransferase levels (P = 0.069), or delayed graft function rate (P = 0.973). Rates of chronic allograft dysfunction and new onset diabetes mellitus after transplantation were similar. Conclusion. Our study revealed that, RTx from HBsAg(+) donors to HBsAg(+) recipients is safe with antiviral treatment.
Marginal donors are increasingly used for transplantation because of insufficient organ donation (1, 2). Therefore, hepatitis B surface antigen positive – HBsAg (+) – donors are used for recipients who do not have healthy donors. There are many handicaps in trans-
V.T. Yilmaz1, _I. Aliosmanoglu2, H. Erbis2, B.V. Ulger3, R. Cetinkaya1, G. Suleymanlar1, H. Kocak1 1
Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey, 2 Department of General Surgery, Akdeniz University Medical School, Antalya, Turkey, 3Department of General Surgery, Dicle University Medical School, Diyarbakir, Turkey
Key words: renal transplantation; hepatitis B virus; acute hepatitis; lamivudine; liver failure Correspondence to: Vural Taner Yilmaz, Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey Tel: +90 (242) 2496122 Fax: +90 (242) 2224444 E-mail: [email protected]
Received 8 June 2015, revised 20 August 2015, accepted for publication 25 September 2015 DOI: 10.1111/tid.12482 Transpl Infect Dis 2016: 18: 55–62
plantation to HBsAg(+) recipients. Liver failure, cirrhosis, hepatocellular carcinoma (HCC), acute exacerbations of hepatitis or fulminant hepatitis may develop in these patients because of immunosuppressive treatment after transplantation (3–5). Hepatitis B
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virus (HBV)-associated glomerulonephritis and HBV reactivation can also develop (6–8). Many studies report different result in HBsAg(+) recipients undergoing renal transplantation (RTx). Some studies showed that HBsAg(+) renal transplant recipients (RTR) had similar outcomes with HBsAg( ) recipients in terms of graft function and graft and patient survival, while other studies showed that HBsAg(+) recipients had worse outcomes. Also, differing results are reported, in terms of liver complications (9–12). The use of nucleoside analogs resulted in the decrease in HBV reactivation, liver failure, cirrhosis, and other liver complications. Also, HBsAg(+) recipients who used nucleoside analogs had similar outcomes with HBsAg ( ) recipients, in terms of graft and patient survival. It is believed that organ transplantation from HBsAg (+) donors can lead to liver complications and acute exacerbations of hepatitis owing to the transferred viral load, and that these complications have negative impacts on graft function, and graft and patient survival. In one study of the outcomes of HBsAg(+) recipients who underwent RTx from HBsAg(+) donors, 1 of the recipients was lost because of liver complications, 1 patient developed graft loss caused by acute rejection, and the remaining 4 recipients had good graft function without any complications at follow-up (13). In our study, we determined the outcomes of the HBsAg(+) RTR whose donors were HBsAg(+). Four of the donors were living donors, while 1 donor was a deceased donor.
Patients and methods A group of 55 patients who underwent RTx in our hospital between 2001 and 2012 were included in the study. The patients were divided into 2 groups and results compared. Group 1 (n = 50, male/female: 40 [80%]/10 [20%]) consisted of HBsAg(+) RTR whose donors were HBsAg( ). Group 2 (n = 5, male/female: 4 [80%]/1 [20%]) consisted of HBsAg(+) RTR whose donors were HBsAg(+). Demographic data, donor sources, mean glomerular filtration rates, etiologies of the chronic renal disease, renal replacement treatment methods, lymphocyte crossmatch results, number of mismatches, immunosuppressive treatment methods, induction treatment methods, and antiviral treatment methods of the groups are listed in Table 1. HBsAg was (+) and hepatitis B surface antibody (HBsAb) was ( ) in all of the recipients who underwent RTx from HBsAg(+) donors. In 4 of these recipients, hepatitis B e antigen (HBeAg) was ( ) and hepatitis B e antibody (HBeAb) was (+), while in 1 recipient,
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HBeAg was (+) and HBeAb was ( ). Preoperative mean HBV DNA titer was 76,242 (20–62,107) copies/ mL. In all of the HBsAg(+) donors, HBsAg was (+), HBsAb was ( ), HBeAg was ( ), and HBeAb was (+). Serum HBV DNA titer in 1 of the donors was 3911 copies/mL. Titers in 2 other donors were
Effects of hepatitis B surface antigen (HBsAg) positivity of donors in HBsAg(+) renal transplant recipients: comparison of outcomes with HBsAg(+) and HBsAg( ) donors _ Aliosmanoglu, H. Erbis, B.V. Ulger, R. Cetinkaya, G. V.T. Yilmaz, I. Suleymanlar, H. Kocak. Effects of hepatitis B surface antigen (HBsAg) positivity of donors in HBsAg(+) renal transplant recipients: comparison of outcomes with HBsAg(+) and HBsAg( ) donors. Transpl Infect Dis 2016: 18: 55–62. All rights reserved Abstract: Aim. The aim of this study was to determine the effects of hepatitis B surface antigen (HBsAg) positivity of the donors on graft survival and liver complications in HBsAg(+) renal transplant recipients. Patients and method. A group of 55 patients who underwent renal transplantation (RTx) in our hospital between 2001 and 2012 were included in the study. Patients were divided into 2 groups. Group 1 (n = 50) consisted of HBsAg(+) renal transplant recipients (RTR) whose donors were HBsAg( ). In Group 2 (n = 5), RTR and donors were both HBsAg(+). Lymphocyte cross matches, number of mismatches, donor types, renal replacement treatment modalities, drugs of induction treatment, and preoperative hepatitis B virus DNA titers of the groups were similar. In Group 1, 42 patients were taking lamivudine, 3 patients were taking entecavir, and 5 patients were taking tenofovir. All of the patients in Group 2 were taking lamivudine. Patient and graft survival rates, graft functions, acute hepatitis rates, acute rejection rates, and other clinical outcomes of the groups were compared. Results. Demographic data of the groups were similar. Acute rejection rates (P = 0.458), graft survival rates (P = 0.515), and patient survival rates (P = 0.803) were also similar. No significant difference was found between the groups in terms of acute hepatitis rate (P = 0.511), glomerular filtration rate (calculated by Modification of Diet in Renal Disease formula) in the last follow-up (P = 0.988), alanine aminotransferase levels (P = 0.069), or delayed graft function rate (P = 0.973). Rates of chronic allograft dysfunction and new onset diabetes mellitus after transplantation were similar. Conclusion. Our study revealed that, RTx from HBsAg(+) donors to HBsAg(+) recipients is safe with antiviral treatment.
Marginal donors are increasingly used for transplantation because of insufficient organ donation (1, 2). Therefore, hepatitis B surface antigen positive – HBsAg (+) – donors are used for recipients who do not have healthy donors. There are many handicaps in trans-
V.T. Yilmaz1, _I. Aliosmanoglu2, H. Erbis2, B.V. Ulger3, R. Cetinkaya1, G. Suleymanlar1, H. Kocak1 1
Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey, 2 Department of General Surgery, Akdeniz University Medical School, Antalya, Turkey, 3Department of General Surgery, Dicle University Medical School, Diyarbakir, Turkey
Key words: renal transplantation; hepatitis B virus; acute hepatitis; lamivudine; liver failure Correspondence to: Vural Taner Yilmaz, Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey Tel: +90 (242) 2496122 Fax: +90 (242) 2224444 E-mail: [email protected]
Received 8 June 2015, revised 20 August 2015, accepted for publication 25 September 2015 DOI: 10.1111/tid.12482 Transpl Infect Dis 2016: 18: 55–62
plantation to HBsAg(+) recipients. Liver failure, cirrhosis, hepatocellular carcinoma (HCC), acute exacerbations of hepatitis or fulminant hepatitis may develop in these patients because of immunosuppressive treatment after transplantation (3–5). Hepatitis B
55
Yilmaz et al: HBsAg(+) donors and HBsAg(+) recipients
virus (HBV)-associated glomerulonephritis and HBV reactivation can also develop (6–8). Many studies report different result in HBsAg(+) recipients undergoing renal transplantation (RTx). Some studies showed that HBsAg(+) renal transplant recipients (RTR) had similar outcomes with HBsAg( ) recipients in terms of graft function and graft and patient survival, while other studies showed that HBsAg(+) recipients had worse outcomes. Also, differing results are reported, in terms of liver complications (9–12). The use of nucleoside analogs resulted in the decrease in HBV reactivation, liver failure, cirrhosis, and other liver complications. Also, HBsAg(+) recipients who used nucleoside analogs had similar outcomes with HBsAg ( ) recipients, in terms of graft and patient survival. It is believed that organ transplantation from HBsAg (+) donors can lead to liver complications and acute exacerbations of hepatitis owing to the transferred viral load, and that these complications have negative impacts on graft function, and graft and patient survival. In one study of the outcomes of HBsAg(+) recipients who underwent RTx from HBsAg(+) donors, 1 of the recipients was lost because of liver complications, 1 patient developed graft loss caused by acute rejection, and the remaining 4 recipients had good graft function without any complications at follow-up (13). In our study, we determined the outcomes of the HBsAg(+) RTR whose donors were HBsAg(+). Four of the donors were living donors, while 1 donor was a deceased donor.
Patients and methods A group of 55 patients who underwent RTx in our hospital between 2001 and 2012 were included in the study. The patients were divided into 2 groups and results compared. Group 1 (n = 50, male/female: 40 [80%]/10 [20%]) consisted of HBsAg(+) RTR whose donors were HBsAg( ). Group 2 (n = 5, male/female: 4 [80%]/1 [20%]) consisted of HBsAg(+) RTR whose donors were HBsAg(+). Demographic data, donor sources, mean glomerular filtration rates, etiologies of the chronic renal disease, renal replacement treatment methods, lymphocyte crossmatch results, number of mismatches, immunosuppressive treatment methods, induction treatment methods, and antiviral treatment methods of the groups are listed in Table 1. HBsAg was (+) and hepatitis B surface antibody (HBsAb) was ( ) in all of the recipients who underwent RTx from HBsAg(+) donors. In 4 of these recipients, hepatitis B e antigen (HBeAg) was ( ) and hepatitis B e antibody (HBeAb) was (+), while in 1 recipient,
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HBeAg was (+) and HBeAb was ( ). Preoperative mean HBV DNA titer was 76,242 (20–62,107) copies/ mL. In all of the HBsAg(+) donors, HBsAg was (+), HBsAb was ( ), HBeAg was ( ), and HBeAb was (+). Serum HBV DNA titer in 1 of the donors was 3911 copies/mL. Titers in 2 other donors were
