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Rituximab and hepatitis B reactivation in HBsAg-negative/ anti-HBc-positive kidney transplant recipients

 Juhan Lee  ;  Jun Yong Park  ;  Kyu Ha Huh  ;  Beom Seok Kim  ;  Myoung Soo Kim  ;  Soon Il Kim  ;  Sang Hoon Ahn  ;  Yu Seun Kim 
 Nephrology Dialysis Transplantation, Vol.32(4) : 722-729, 2017 
Journal Title
 Nephrology Dialysis Transplantation 
Issue Date
Antineoplastic Agents/pharmacology ; Cohort Studies ; Drug Resistance, Viral* ; Female ; Hepatitis B/blood ; Hepatitis B/diagnosis ; Hepatitis B/etiology ; Hepatitis B/transmission* ; Hepatitis B Antibodies/blood* ; Hepatitis B Surface Antigens/blood* ; Hepatitis B virus/physiology* ; Humans ; Kidney Transplantation/adverse effects* ; Male ; Middle Aged ; Risk Factors ; Rituximab/pharmacology* ; Transplant Recipients ; Virus Activation/drug effects*
hepatitis B virus ; immunosuppression ; kidney transplantation ; reactivation ; rituximab
BACKGROUND: Hepatitis B virus (HBV) reactivation is a well-known complication of immunosuppressive therapy. Although rituximab is increasingly used for desensitization of ABO-incompatible or positive crossmatch kidney transplantation, the risk of HBV reactivation in hepatitis B surface antigen (HBsAg)-negative/hepatitis B core antibody (anti-HBc)-positive kidney transplant patients receiving rituximab desensitization remains undetermined. METHODS: We analysed 172 resolved HBV patients who underwent living donor kidney transplantation between 2008 and 2014. Patients were divided into rituximab ( n  =  49) or control ( n  =  123) groups. All patients were observed for HBV reactivation, which was defined as the reappearance of hepatitis B surface antigen or HBV DNA. RESULTS: During the follow-up period (median, 58 months; range, 4-95 months), five patients (10.2%) in the rituximab group and two patients (1.6%) in the control group experienced HBV reactivation (P   =   0.003). In the rituximab group, two patients experienced HBV-related severe hepatitis, and one patient died due to hepatic failure. The median time from rituximab desensitization to HBV reactivation was 11 months (range, 5-22 months). By contrast, no patients in the control group experienced severe hepatitis. The status of hepatitis B surface antibody was similar between groups. Rituximab desensitization [hazard ratio (HR), 9.18; 95% confidence interval (CI), 1.74-48.86; P   =   0.009] and hepatitis B surface antibody status (HR, 4.74; 95% CI, 1.05-21.23, P =   0.04) were significant risk factors for HBV reactivation. CONCLUSIONS: Rituximab desensitization for incompatible kidney transplantation significantly increased the risk of HBV reactivation in HBsAg-negative/anti-HBc-positive patients. Therefore, close monitoring of HBV DNA is required in these patients.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김명수(Kim, Myoung Soo) ORCID logo https://orcid.org/0000-0002-8975-8381
김범석(Kim, Beom Seok) ORCID logo https://orcid.org/0000-0002-5732-2583
김순일(Kim, Soon Il) ORCID logo https://orcid.org/0000-0002-0783-7538
김유선(Kim, Yu Seun) ORCID logo https://orcid.org/0000-0002-5105-1567
박준용(Park, Jun Yong) ORCID logo https://orcid.org/0000-0001-6324-2224
안상훈(Ahn, Sang Hoon) ORCID logo https://orcid.org/0000-0002-3629-4624
이주한(Lee, Ju Han)
허규하(Huh, Kyu Ha) ORCID logo https://orcid.org/0000-0003-1364-6989
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