Incidence of Hepatitis B Viral Reactivation After Kidney Transplantation With Low-Dose Rituximab Administration.

Abstract

BACKGROUND:

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

METHODS:

In this retrospective cohort study consisting of 1294 kidney transplant patients, we identified 76 patients showing preoperative hepatitis B surface antigen-negative, hepatitis B core antibody-positive, and HBV-DNA-negative results. A rituximab dose of 200 mg/body was administered to 48 patients, 46 of whom did not receive prophylaxis (RIT+ group). Twenty-eight patients received neither rituximab nor prophylaxis (RIT- group). We monitored HBV-DNA by polymerase chain reaction every 1 to 3 months, and HBV reactivation was defined as detectable HBV-DNA.

RESULTS:

HBV reactivation was found in 1 patient in the RIT+ group (2.2%) and 1 patient in the RIT- group (3.6%) at 6 weeks and 5.5 years posttransplant, respectively, but spontaneously cleared. Both patients showed positive hepatitis B surface antibody preoperatively. HBV reactivation was not found in 6 patients lacking anti-hepatitis B surface preoperatively.

CONCLUSIONS:

Low-dose RIT administration in kidney transplant patients without prophylaxis is associated with low incidence of HBV reactivation. However, the comparisons among standard-dose RIT, low-dose RIT, and controls with high-quality study design is necessary.

• Authors: Kosuke Masutani, Kazuya Omoto, Masayoshi Okumi, Yasuhiro Okabe, Tomokazu Shimizu, Kazuhiko Tsuruya, Takanari Kitazono, Masafumi Nakamura, Hideki Ishida, Kazunari Tanabe, Japan Academic Consortium of Kidney Transplantation (JACK) Investigators.
• Journal: Transplantation (Transplantation) Vol. 102 Issue 1 Pg. 140-145 (01 2018) ISSN: 1534-6080 [Electronic] United States
• PMID: 28665891 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Rituximab

Topics

• Adult
• Aged
• Female
• Graft Rejection (epidemiology)
• Hepatitis B virus (physiology)
• Humans
• Incidence
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Retrospective Studies
• Rituximab (pharmacology)
• Virus Activation (drug effects)