Document Detail

Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients.
MedLine Citation:
PMID:  25179509     Owner:  NLM     Status:  Publisher    
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.
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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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-29
Journal Detail:
Title:  The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases     Volume:  -     ISSN:  1678-4391     ISO Abbreviation:  Braz J Infect Dis     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-9-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9812937     Medline TA:  Braz J Infect Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014. Published by Elsevier Editora Ltda.
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