PDF(Pubmed)
Abstract：
UNASSIGNED: Hepatitis B virus (HBV) reactivation in kidney transplant recipients has been reported in 3% to 9% of anti-HBc antibody (HBcAb)-positive HBs antigen (HBsAg)-negative patients. It has not been studied in patients receiving belatacept, a selective costimulation blocker.
UNASSIGNED: We performed a retrospective study of all transplant recipients receiving belatacept in 2 kidney transplantation centers in France. Among HBcAb-positive patients, we analyzed HBV reactivation rate, outcomes, and risk factors.
UNASSIGNED: A total of 135 patients treated with belatacept were included: 32 were HBcAb-positive and 2 were HBsAg-positive. Seven patients reactivated HBV (21.9% of HBcAb-positive patients), including 5 HBsAg-negative patients (16.7% of HBcAb-positive HBsAg-negative patients). Reactivation occurred 54.8 (± 70.9) months after transplantation. One patient presented with severe hepatitis and 1 patient developed cirrhosis. There was no significant difference in survival between patients that reactivated HBV and patients that did not: 5-year patient survival of 100% (28.6; 100) and 83.4% (67.6; 100), respectively (P = 0.363); and 5-year graft survival of 100% (28.6; 100) and 79.8% (61.7; 100), respectively (P = 0.335). No factor, including HBsAb positivity and antiviral prophylaxis, was statistically associated with the risk of HBV reactivation.
UNASSIGNED: HBV reactivation rate was high in patients treated with belatacept when compared with previous transplantation studies. HBV reactivation did not impact survival. Further studies are needed to confirm these results. A systematic antiviral prophylaxis for these patients should be considered and evaluated.
UNASSIGNED: We performed a retrospective study of all transplant recipients receiving belatacept in 2 kidney transplantation centers in France. Among HBcAb-positive patients, we analyzed HBV reactivation rate, outcomes, and risk factors.
UNASSIGNED: A total of 135 patients treated with belatacept were included: 32 were HBcAb-positive and 2 were HBsAg-positive. Seven patients reactivated HBV (21.9% of HBcAb-positive patients), including 5 HBsAg-negative patients (16.7% of HBcAb-positive HBsAg-negative patients). Reactivation occurred 54.8 (± 70.9) months after transplantation. One patient presented with severe hepatitis and 1 patient developed cirrhosis. There was no significant difference in survival between patients that reactivated HBV and patients that did not: 5-year patient survival of 100% (28.6; 100) and 83.4% (67.6; 100), respectively (P = 0.363); and 5-year graft survival of 100% (28.6; 100) and 79.8% (61.7; 100), respectively (P = 0.335). No factor, including HBsAb positivity and antiviral prophylaxis, was statistically associated with the risk of HBV reactivation.
UNASSIGNED: HBV reactivation rate was high in patients treated with belatacept when compared with previous transplantation studies. HBV reactivation did not impact survival. Further studies are needed to confirm these results. A systematic antiviral prophylaxis for these patients should be considered and evaluated.
摘要：
■肾移植受者中乙型肝炎病毒（HBV）的再激活已在3％至9％的抗HBc抗体（HBcAb）阳性HBs抗原（HBsAg）阴性患者中报道。尚未在接受belatacept的患者中进行研究，选择性共刺激阻断剂。
■我们在法国的2个肾脏移植中心对所有接受belatacept的移植受者进行了回顾性研究。在HBcAb阳性患者中，我们分析了HBV再激活率，结果，和风险因素。
■共有135例患者接受belatacept治疗：32例HBcAb阳性，2例HBsAg阳性。7例患者重新激活HBV（HBcAb阳性患者的21.9％），包括5例HBsAg阴性患者（HBcAb阳性HBsAg阴性患者的16.7％）。移植后54.8（±70.9）个月发生再激活。1例患者出现严重肝炎，1例患者出现肝硬化。再激活HBV的患者和未激活HBV的患者之间的生存率没有显着差异：5年患者生存率为100％（28.6;100）和83.4％（67.6;100），分别（P=0.363）；5年移植物存活率为100％（28.6;100）和79.8％（61.7;100），分别(P=0.335)。没有因素，包括HBsAb阳性和抗病毒预防，在统计学上与HBV再激活的风险相关。
■与以前的移植研究相比，接受belatacept治疗的患者HBV再激活率高。HBV再激活并不影响生存。需要进一步的研究来证实这些结果。应考虑和评估这些患者的系统抗病毒预防。
■我们在法国的2个肾脏移植中心对所有接受belatacept的移植受者进行了回顾性研究。在HBcAb阳性患者中，我们分析了HBV再激活率，结果，和风险因素。
■共有135例患者接受belatacept治疗：32例HBcAb阳性，2例HBsAg阳性。7例患者重新激活HBV（HBcAb阳性患者的21.9％），包括5例HBsAg阴性患者（HBcAb阳性HBsAg阴性患者的16.7％）。移植后54.8（±70.9）个月发生再激活。1例患者出现严重肝炎，1例患者出现肝硬化。再激活HBV的患者和未激活HBV的患者之间的生存率没有显着差异：5年患者生存率为100％（28.6;100）和83.4％（67.6;100），分别（P=0.363）；5年移植物存活率为100％（28.6;100）和79.8％（61.7;100），分别(P=0.335)。没有因素，包括HBsAb阳性和抗病毒预防，在统计学上与HBV再激活的风险相关。
■与以前的移植研究相比，接受belatacept治疗的患者HBV再激活率高。HBV再激活并不影响生存。需要进一步的研究来证实这些结果。应考虑和评估这些患者的系统抗病毒预防。
