Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients
Autor: | Christini Takemi Emori, Renata Melo Perez, Carla Adriana Loureiro de Matos, Silvia Naomi Oliveira Uehara, Patricia da Silva Fucuta Pereira, Ana Cristina Amaral Feldner, Roberto José de Carvalho-Filho, Ivonete Sandra de Souza e Silva, Antonio Eduardo Benedito Silva, Maria Lucia Gomes Ferraz |
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Jazyk: | angličtina |
Rok vydání: | 2014 |
Předmět: | |
Zdroj: | Brazilian Journal of Infectious Diseases, Vol 18, Iss 6, Pp 625-630 (2014) |
Druh dokumentu: | article |
ISSN: | 1413-8670 |
DOI: | 10.1016/j.bjid.2014.06.004 |
Popis: | Introduction: There is scarce information regarding clinical evolution of HBV infection in renal transplant patients. Aims: To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis. Materials and methods: HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5× ULN and/or >3× baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis. Results: 140 HBV-infected renal transplant patients were included (71% males; age 46 ± 10 years; post-renal transplant time 8 ± 5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4 ± 3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect. Conclusions: Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients. Keywords: Renal transplantation, Hepatitis B, ALT flare, Lamivudine |
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