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Kidney Week

Abstract: FR-PO911

Presence of Anti-HBs Confers Protection Against Hepatitis B Virus Infection in HBsAg-Negative and Anti-HBc-Positive Patients Undergoing Kidney Transplantation

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Jeon, Jae wan, Chungnam National University Hospital, Daejeon, Korea (the Republic of)
  • Lee, Kang Wook, Chungnam National University Hospital, Daejeon, Korea (the Republic of)
  • Na, Ki Ryang, Chungnam National University Hospital, Daejeon, Korea (the Republic of)
  • Ham, Youngrok, Chungnam National University Hospital, Daejeon, Korea (the Republic of)
  • Choi, Dae Eun, Chungnam National University, Daejeon, Korea (the Republic of)
  • Kim, Haeri, Chungnam National University Hospital, Daejeon, Korea (the Republic of)
Background

The American Gastroenterological Association (AGA) and European Association for the Study of the Liver (EASL) recommend that hepatitis B surface antigen (HBsAg)-negative and hepatitis B core antibody (anti-HBc)-positive patients who receive immunosuppression should be monitored for hepatitis B virus (HBV) infection regardless of hepatitis B surface antibody (anti-HBs) status. However, anti-HBs may provide protection against HBV infection. To investigate whether the presence of anti-HBs in addition to anti-HBc confers protection, we classified HBsAg-negative kidney transplantation (KT) patients into 4 groups according to anti-HBc and anti-HBs status, and compared the HBV infection rate between the anti-HBc(+)/anti-HBs(+) group and the other 3 groups.

Methods

In this single-center retrospective study, we classified 1,959 patients into 4 groups: anti-HBc(-)/anti-HBs(-) (n=356), anti-HBc(-)/antiHBs(+) (n=652), anti-HBc(+)/anti-HBs(-) (n=142), and anti-HBc(+)/anti-HBs(+) (n=809).

Results

HBV infection was noted in 31 patients (1.6%) after KT. There was a significant difference in HBV infection rate between anti-HBc(+)/anti-HBs(+) (1.2%) and anti-HBc(+)/anti-HBs(-) (5.6%) (p<0.001), but not between anti-HBc(+)/anti-HBs(+) and anti-HBc(-)/anti-HBs(-) (1.1%) or anti-HBc(-)/anti-HBs(+) (1.4%). There was a significant difference in HBV infection rate according to anti-HBs titer, but no difference according to the donor viral profile. Hepatic failure occurred in 1 anti-HBc(+)/anti-HBs(-) patient and 1 anti-HBc(+)/anti-HBs(+) patient, both of whom died. Hepatocellular carcinoma was noted in 4 anti-HBc(-) patients, but not in anti-HBc(+) patients.

Conclusion

The presence of anti-HBs confers protection against HBV infection. The EASL or AGA guidelines may be modified to indicate that monitoring should be performed for HBV infection after KT in HBsAg(-)/anti-HBc(+)/anti-HBs(-) patients, but not in HBsAg(-)/anti-HBc(+)/anti-HBs(+) patients.