Prevention of hepatitis B virus reactivation in kidney transplant recipients

Abstract

BACKGROUND AND OBJECTIVE: Hepatitis B virus (HBV) reactivation is a major risk factor for hepatic dysfunction, acute or chronic hepatitis, cirrhosis, or hepatocellular carcinoma after kidney transplantation (KTP). The present article summarizes some of published articles about prevention of HBV reactivation in renal transplant recipients METHODS: Many articles published in English language as full-text manuscripts reviewed in a variety of sources such as Scopus, Pub Med and Google Scholar with key words of hepatitis B and kidney transplantation to collect current data about this issue. FINDINGS: The risk of reactivation of HBV followingKTP is related to the status of serologic markers of HBV at the time of KTP.KTP candidate patients who are hepatitis B surface antigen (HBsAg) positivehave higher risk for reactivation especially those who are hepatitis B e antibody positive or have high levels of HBV DNA in serum. Lamivudine has been most extensively used for prevention of HBV reactivation, but it is associated with a high rate of drug resistance.It seems that the optimal antiviral agent for prevention of HBV reactivation is entecavir which is associated with the lowest risk of drug resistance,however lamivudine-resistant HBV is less sensitive to entecavir. The preferred antiviral agent for lamivudine-resistant HBV is tenofovir which should be added to lamivudine rather than stopping lamivudine. It is reported that combination therapy in this sitting may reduce the development of resistance to the second drug. CONCLUSION: There is sufficient evidence to recommend routine antiviral prophylaxis for all HBsAg-positive patients who are undergoing kidney transplantation. � 2016, Babol University of Medical Sciences. All rights reserved.