Pre-transplant donor HBV DNA+ and male recipient are independent risk factors for treatment failure in HBsAg+ donors to HBsAg- kidney transplant recipients

Wang, Xian-ding; Feng, Shi-jian; Liu, Jin-peng; Song, Tu-run; Huang, Zhong-li; Fan, Yu; Shi, Yun-ying; Chen, Li-yu; Lv, Yuan-hang; Xu, Zi-lin; Li, Xiao-hong; Wang, Li; Lin, Tao

doi:10.1186/s12879-020-05704-1

Table 2 Pre/post-transplant HBV serology and post-transplant complications in the two groups

From: Pre-transplant donor HBV DNA+ and male recipient are independent risk factors for treatment failure in HBsAg+ donors to HBsAg- kidney transplant recipients

	D(HBsAg+)/R(HBsAg-) group (n = 83)	D(HBcAb+)/R(HBcAb-) group (n = 83)	P value
Donors’ pre-transplant HBV serology
HBsAg+	83 (100%)	0	< 0.001
HBsAb+	3 (3.6%)	58 (69.9%)	< 0.001
HBeAg+	0	0	/
HBeAb+	78 (94.0%)	35 (42.2%)	< 0.001
HBcAb+	82 (98.8%)	83 (100%)	1.000
HBV DNA+	24 (28.9%)	Unknown^a	/
Recipients’ pre-transplant HBV serology
HBsAg+	0	0	/
HBsAb+	63 (75.9%)	63 (75.9%)	1.000
HBsAb titer > 100	32 (38.6%)	32 (38.6%)	1.000
HBeAg+	0	0	/
HBeAb+	34 (41.0%)	0	< 0.001
HBcAb+	58 (69.9%)	0	< 0.001
HBV DNA+	0	Unknown^a	/
Recipients’ most recent HBV serology
HBV DNA - → +	2^b (2.4%)	0	0.477
HBsAg - → +	2^b (2.4%)	0	0.477
HBeAg - → +	1 (1.2%)	0	1.000
HBeAb - → +	4 (4.8%)	0	0.129
HBeAb + → -	4 (4.8%)	0	0.129
HBcAb - → +	7 (8.4%)	2 (2.4%)	0.170
HBsAb titer downgrade	1 (1.2%)	11 (13.3%)	0.012
HBsAb titer upgrade	13 (15.7%)	2 (2.4%)	0.013
Recipients’ post-transplant complications
Treatment failure	18 (21.7%)	9 (10.8%)	< 0.001
Delayed graft function	2 (2.4%)	0	0.477
Rejection	12 (14.5%)	12 (14.5%)	1.000
Infection	34 (41.0%)	22 (26.5%)	0.071
Graft loss	4 (4.8%)	4 (4.8%)	1.000
Recipient death	5 (6.0%)	1 (1.2%)	0.216
Abnormal liver function	29 (34.9%)	32 (38.6%)	0.650
Active liver injury	8 (9.6%)	2 (2.4%)	0.048
Malignancy	0	0	/

^aWe did not test the pre-transplant HBV DNA levels of the donors or recipients in the D(HBcAb+)/R(HBcAb-) group
^b Two recipients in the D(HBsAg+)/R(HBsAg-) group developed post-transplant HBV DNA+ accompanied with HBsAg+. The first recipient: 32-year-old male, pre-transplant donor/recipient HBV serology was HBV DNA −/−, HBsAg +/−, HBsAb −/−, HBeAg −/−, HBeAb +/−, HBcAb +/−. His prophylaxis was lamivudine alone for 1.5 months. The recipient experienced a temporary rise of ALT, up to 163 IU/L 1 year after transplantation. Then he was lost to follow-up during post-transplant years 1.5–5.5. He was found to have HBV DNA+ (5.02 × 10⁴ IU/ml), HBsAg+, HBeAb+, and HBcAb+, ALT 55 IU/L when admitted due to pulmonary infection 5.5 years after transplantation. He received long-term entecavir monotherapy until he died of pulmonary infection 7 years after transplantation. The second recipient: 24-year-old male, pre-transplant donor/recipient HBV serology was HBV DNA + (1.14 × 10³ IU/mL)/−, HBsAg +/−, HBsAb −/−, HBeAg −/−, HBeAb +/−, HBcAb +/−. His prophylaxis was HBIG 2000 IU and lamivudine for 2 months. He received a total of 1500 mg Intravenous methylprednisolone to treat acute rejection 5 months after transplantation. He became HBV DNA+ (> 5.00 × 10⁷ IU/mL), HBsAg+, and HBcAb+ 6 months after transplantation. His total bilirubin level rapidly increased from 26 μmol/L at month 6 to 489 μmol/L at month 8 when he died of liver failure and pulmonary infection

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ISSN: 1471-2334

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