Hepatitis B Virus Reactivation in Kidney Transplant Recipients With Core Antibody Seropositivity: Effects of Preemptive Therapy.

Abstract

Objectives: Hepatitis B virus reactivation, particularly when occurring under immunosuppressive therapy, poses a risk for patients with chronic or resolved hepatitis B virus infections. This study aimed to evaluate the incidence and clinical outcomes of hepatitis B virus reactivation in kidney transplant recipients with resolved hepatitis B virus infection.

Materials and methods: We retrospectively screened patients who underwent kidney transplant between 2012 and 2023 seen at our center (Izmir, Türkiye ). We included transplant recipients with resolved hepatitis B virus infection. We analyzed risk factors associated with reactivation and the clinical course of patients who developed hepatitis B virus reactivation.

Results: Our analyses included 95 kidney transplant recipients; mean follow -up period was 70 ± 31 months. Baseline serology revealed that 9.4 % of patients had isolated anti -HBc positivity, whereas 90.6 % were positive for both anti -HBc and anti -HBs. None of the patients received antiviral prophylaxis at baseline; however, 14 patients received prophylaxis during the follow -up period. Among the 81 transplant recipients who did not receive prophylaxis, hepatitis B virus reactivation occurred in 3 patients (3.7 % ). No serious adverse outcomes, such as liver failure, liver transplant, or death due to hepatitis B virus reactivation were observed.

Conclusions: Although hepatitis B virus reactivation is uncommon in hepatitis B surface antigen -negative /anti -HBc -positive patients after kidney transplant, reactivation remains a potential risk. In patients not scheduled for long -term prophylaxis, careful assessment regarding the necessity, efficacy, and safety of antiviral intervention is critical for optimal management.