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Kidney Week

Abstract: SA-PO494

Incidence of Hepatitis B Virus Reactivation after Kidney Transplantation with Low-Dose Rituximab Administration

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational


  • Masutani, Kosuke, Kyushu University, Fukuoka, Japan
  • Omoto, Kazuya, Tokyo Women's Medical University, Tokyo, Japan
  • Okumi, Masayoshi, Tokyo Women's Medical University, Tokyo, Japan
  • Okabe, Yasuhiro, Kyushu University Hospital, Fukuoka, Japan
  • Shimizu, Tomokazu, Tokyo Women's Medical University, Tokyo, Japan
  • Tsuruya, Kazuhiko, Kyushu University, Fukuoka, Japan
  • Kitazono, Takanari, Department of Medicine and Clinical Science, Fukuoka, Japan
  • Ishida, Hideki, Tokyo Women's Medical University, Tokyo, Japan
  • Tanabe, Kazunari, Tokyo Women's Medical University, Tokyo, Japan

Group or Team Name

  • Japan Academic Consortium of Kidney Transplantation (JACK) Investigators

In patients with hematological malignancy who are intended to receive rituximab, hepatitis B virus (HBV) serology screening and viral reactivation monitoring are recommended. However, the effect of single-dose rituximab on HBV reactivation in kidney transplant (KT) patients with previous HBV infection is still unclear.


In this retrospective cohort study of 1,294 KT patients, we identified 76 who were negative for preoperative hepatitis B surface antigen and HBV DNA, and positive for hepatitis B core antibody. A rituximab dose of 200 mg/body was administered to 48 patients; 46 of whom did not receive prophylaxis (rituximab + group). Twenty-eight patients received neither rituximab nor prophylaxis (rituximab − group). We monitored HBV DNA by polymerase chain reaction every 1–3 months, and HBV reactivation was defined as detectable HBV DNA.


HBV reactivation was found in one patient in the rituximab + group (2.2%) and one in the rituximab − group (3.6%) at 6 weeks and 5.5 years post-KT, respectively, but it was spontaneously cleared. Both patients were positive for hepatitis B surface antibody (anti-HBs) preoperatively. HBV reactivation was not found in six patients lacking anti-HBs preoperatively.


Low-dose rituximab administration in KT patients without prophylaxis is associated with a low incidence of HBV reactivation. However, the sequential monitoring is necessary for many years to detect viral reactivation and prevent de novo hepatitis.