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Ordaya EE, Shaughnessy M, Elkin B, Husmann RL, Stauffer JC, Luengas EM, Chang BH, Tessier KM, Walker PF, Stauffer WM. Transplantation and immigration: Comparing infectious complications and outcomes between foreign-born and US-born kidney transplant recipients in Minnesota. Transpl Infect Dis 2023; 25:e14039. [PMID: 36856346 PMCID: PMC10085839 DOI: 10.1111/tid.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Foreign-born kidney transplant recipients (FBKTRs) are at increased risk for reactivation of latent infections that may impact outcomes. We aimed to compare the etiology of infections and outcomes between FBKTR and United States KTRs (USKTR). METHODS We performed a retrospective study of patients who underwent kidney transplantation between January 1, 2014 and December 31, 2018 at two transplant centers in Minnesota. Frequency and etiology of infections as well as outcomes (graft function, rejection, and patient survival) at 1-year post-transplant between FBKTR and USKTR were compared. RESULTS Of the 573 transplant recipients, 124 (21.6%) were foreign-born and 449 (78.4%) US-born. At least one infection occurred in 411 (71.7%) patients (38.2% bacterial, 55% viral, 9.4% fungal). Viral infections were more frequent in FBKTR, particularly BK viremia (38.7% vs. 21.2%, p < .001). No statistical differences were found for bacterial or fungal infections; no parasitic infections were identified in either group. No geographically-restricted infections were noted aside from a single case of Madura foot in a FBKTR. Rejection episodes were more common in USKTR (p = .037), but stable/improving graft function (p = .976) and mortality (p = .451) at 1-year posttransplantation were similar in both groups. After adjusting for covariates, previous transplantation was associated with a higher number of infections (IRR 1.35, 95% confidence intervals 1.05-1.73, p = .020). CONCLUSION Although viral infections were more frequent in FBKTR, overall frequency and etiology of most infections and outcomes were similar between FBKTR and USKTR suggesting that comprehensive transplant care is providing timely prevention, diagnosis, and treatment of latent infections in FBKTR.
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Affiliation(s)
- Eloy E. Ordaya
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Megan Shaughnessy
- Department of Medicine, Hennepin HealthCare, Minneapolis, Minnesota
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Baila Elkin
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rachel L. Husmann
- Department of Medicine, Hennepin HealthCare, Minneapolis, Minnesota
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jacob C. Stauffer
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Bickey H. Chang
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Katelyn M. Tessier
- Masonic Cancer Center, Biostatistics Core, University of Minnesota, Minneapolis, Minnesota
| | - Patricia F. Walker
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Institute, Minneapolis, Minnesota
| | - William M. Stauffer
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
- Human Migration and Health, Center for Global Health and Social Responsibility, Minneapolis, Minnesota
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Yin S, Zhang F, Wu J, Lin T, Wang X. Incidence, risk factors, and clinical outcomes of HBV reactivation in non-liver solid organ transplant recipients with resolved HBV infection: A systematic review and meta-analysis. PLoS Med 2023; 20:e1004196. [PMID: 36920988 PMCID: PMC10058170 DOI: 10.1371/journal.pmed.1004196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/29/2023] [Accepted: 02/09/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Current guidelines do not recommend routine antiviral prophylaxis to prevent hepatitis B virus (HBV) reactivation in non-liver solid organ transplant (SOT) recipients with resolved HBV infection, even in anti-hepatitis B surface antigen (anti-HBs)-negative recipients and those receiving intense immunosuppression. This systematic review and meta-analysis aimed to determine the incidence, risk factors, and clinical outcomes of HBV reactivation in non-liver SOT recipients. METHODS AND FINDINGS Three databases (PubMed, Embase, and Cochrane Library) were systematically searched up to December 31, 2022. Clinical studies reporting HBV reactivation in non-liver SOT recipients were included. Case reports, case series, and cohort studies with a sample size of less than 10 patients were excluded. Random-effects analysis was used for all meta-analyses. We included 2,913 non-liver SOT recipients with resolved HBV infection from 16 retrospective cohort studies in the analysis. The overall HBV reactivation rate was 2.5% (76/2,913; 95% confidence interval [95% CI 1.6%, 3.6%]; I2 = 55.0%). Higher rates of reactivation were observed in recipients with negative anti-HBs (34/421; 7.8%; 95% CI [5.2%, 10.9%]; I2 = 36.0%) by pooling 6 studies, experiencing acute rejection (13/266; 5.8%; 95% CI [2.3%, 14.5%]; I2 = 63.2%) by pooling 3 studies, receiving ABO blood type-incompatible transplantation (8/111; 7.0%; 95% CI [2.9%, 12.7%]; I2 = 0%) by pooling 3 studies, receiving rituximab (10/133; 7.3%; 95% CI [3.4%, 12.6%]; I2 = 0%) by pooling 3 studies, and receiving anti-thymocyte immunoglobulin (ATG, 25/504; 4.9%; 95% CI [2.5%, 8.1%]; I2 = 49.0%) by pooling 4 studies. Among recipients with post-transplant HBV reactivation, 11.0% (7/52; 95% CI [4.0%, 20.8%]; I2 = 0.3%) developed HBV-related hepatic failure, and 11.0% (7/52; 95% CI [4.0%, 20.8%]; I2 = 0.3%) had HBV-related death. Negative anti-HBs (crude odds ratio [OR] 5.05; 95% CI [2.83, 9.00]; p < 0.001; I2 = 0%), ABO blood type-incompatible transplantation (crude OR 2.62; 95% CI [1.05, 6.04]; p = 0.040; I2 = 0%), history of acute rejection (crude OR 2.37; 95% CI [1.13, 4.97]; p = 0.022; I2 = 0%), ATG use (crude OR 3.19; 95% CI [1.48, 6.87]; p = 0.003; I2 = 0%), and rituximab use (crude OR 3.16; 95% CI [1.24, 8.06]; p = 0.016; I2 = 0%) increased the risk of reactivation. Adjusted analyses reported similar results. Limitations include moderate heterogeneity in the meta-analyses and that most studies were conducted in kidney transplant recipients. CONCLUSIONS Non-liver SOT recipients with resolved HBV infection have a high risk of HBV-related hepatic failure and HBV-related death if HBV reactivation occurs. Potential risk factors for HBV reactivation include rituximab use, anti-thymocyte immunoglobulin use, anti-HBs negative status, acute rejection history, and ABO blood type-incompatible transplantation. Further research on monitoring and routine antiviral prophylaxis of non-liver SOT recipients at higher risk of HBV reactivation is required.
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Affiliation(s)
- Saifu Yin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Fan Zhang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Jiapei Wu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Tao Lin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- * E-mail: (TL); (XW)
| | - Xianding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- * E-mail: (TL); (XW)
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Tsai HJ, Wu MJ, Chen CH, Yang SS, Huang YH, Chang YZ, Chang HR, Lee TY. Risk Stratification for Hepatitis B Virus Reactivation in Kidney Transplant Recipients With Resolved HBV Infection. Transpl Int 2023; 36:11122. [PMID: 37125384 PMCID: PMC10134034 DOI: 10.3389/ti.2023.11122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/31/2023] [Indexed: 05/02/2023]
Abstract
The prophylaxis strategy for hepatitis B virus (HBV) reactivation in kidney transplant recipients (KTRs) with resolved HBV infection remains unclear. In this hospital-based retrospective cohort study, consecutive KTRs with resolved HBV infection were screened from the years 2000 through 2020. After excluding confounding conditions, 212 and 45 patients were respectively recruited into Anti-HBs positive and Anti-HBs negative groups. Cumulative incidences of, and subdistribution hazard ratios (SHRs) for HBV reactivation were analyzed after adjusting the competing risk. During a median 8.3 (mean 8.4 ± 4.9) years of follow-up, the 10-year cumulative incidence of HBV reactivation was significantly higher in Anti-HBs negative group when compared to that in Anti-HBs positive group (15.2%, 95% CI: 3.6-26.7 vs. 1.3%, 95% CI: 0.0-3.0; p < 0.001). In multivariable regression analysis, absence of anti-HBs (SHR 14.2, 95% CI: 3.09-65.2; p < 0.001) and use of high-dose steroids, i.e., steroid dose ≥20 mg/day of prednisolone equivalent over 4 weeks (SHR 8.96, 95% CI: 1.05-76.2; p = 0.045) were independent risk factors related to HBV reactivation. Accordingly, the 10-year cumulative incidence of HBV reactivation occurring in patients with two, one and zero risk factors was 42.7% (95% CI: 0.0-87.1), 7.9% (95% CI: 1.2-14.7) and 0%, respectively (p < 0.001). In conclusion, the strategy of HBV antiviral prophylaxis may be defined according to the risk stratification.
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Affiliation(s)
- Hsin-Ju Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ming-Ju Wu
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yan-Zin Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Clinical Laboratory, Drug Testing Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Horng-Rong Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- *Correspondence: Horng-Rong Chang, ; Teng-Yu Lee,
| | - Teng-Yu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- *Correspondence: Horng-Rong Chang, ; Teng-Yu Lee,
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Shaikh SA, Kahn J, Aksentijevic A, Kawewat-Ho P, Bixby A, Rendulic T, Park JM. A multi-center evaluation of hepatitis B reactivation with and without antiviral prophylaxis after kidney transplantation. Transpl Infect Dis 2021; 24:e13751. [PMID: 34725887 DOI: 10.1111/tid.13751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg) negative and hepatitis B core antibody (anti-HBc) positive kidney transplant recipients ranges between 1.4-9.6%. Limited evidence is available regarding routine antiviral prophylaxis and identifiable risk factors for HBV reactivation in this population. METHODS In this multi-center retrospective study, we evaluated the prevalence of HBV reactivation in HBsAg-negative anti-HBc-positive kidney transplant recipients who did or did not receive antiviral prophylaxis. The primary outcome assessed the prevalence of HBV reactivation, defined as a positive HBV DNA by PCR of any viral load at or above the minimal detection level. The principal safety outcomes assessed 1-year graft survival, 1-year all-cause mortality, biopsy proven acute rejection (BPAR), and antibody mediated rejection (AMR). RESULTS One-hundred sixty-one patients met inclusion criteria and comprised of two groups, antiviral prophylaxis (n=14) and no antiviral prophylaxis (n=147). Of patients who did not receive prophylaxis only five (3.4%) experienced HBV reactivation whereas one (7.1%) patient in the prophylaxis group experienced reactivation over a median follow-up of 1103 days (p= 0.43). Furthermore, there were no differences with respect to all secondary outcomes. Statistical analysis demonstrated delayed graft function to be a significant factor associated with HBV reactivation. CONCLUSION These study results suggest that the prevalence of HBV reactivation in HBsAg-negative anti-HBc-positive kidney transplant recipients is low, regardless of antiviral prophylaxis. Furthermore, there were no significant graft related outcomes among those that did experience reactivation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Suhail A Shaikh
- Keck Hospital of USC, Department of Transplant Surgery, University of Southern California, 1516 San Pablo St. #3269, Los Angeles, CA, 90033, USA
| | - Jeffrey Kahn
- Keck School of Medicine, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA
| | | | - Pnada Kawewat-Ho
- Keck Hospital of USC, Department of Transplant Surgery, University of Southern California, Los Angeles, CA, USA
| | - Alexandra Bixby
- University Hospitals Cleveland Medical Center, Department of Pharmacy Services, Cleveland, OH, USA
| | - TrisAnn Rendulic
- University of Kentucky HealthCare, Department of Pharmacy Services, Lexington, KY, USA
| | - Jeong M Park
- University of Michigan College of Pharmacy, Department of Clinical Pharmacy, Ann Arbor, MI, USA
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Srisuwarn P, Sumethkul V. Kidney transplant from donors with hepatitis B: A challenging treatment option. World J Hepatol 2021; 13:853-867. [PMID: 34552692 PMCID: PMC8422915 DOI: 10.4254/wjh.v13.i8.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/22/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation. However, the risk of hepatitis B virus (HBV) transmission remains a challenge that undermines the chance of organs being used. This is particularly true with hepatitis B surface antigen (HBsAg) positive donors despite the comparable long-term outcomes when compared with standard donors. To reduce the risk of HBV transmission, a comprehensive approach is needed. This includes assessment of donor risk, optimal allocation to the proper recipient, appropriate immunosuppressive regimen, optimizing the prophylactic therapy, and post-transplant monitoring. This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment. The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening, optimal recipient selection, importance of hepatitis B immunity, role of nucleos(t)ide analogues, and hepatitis B immunoglobulin. A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.
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Affiliation(s)
- Praopilad Srisuwarn
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Vasant Sumethkul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Galiatsatos P, Assouline S, Gologan A, Hilzenrat N. Rituximab-induced autoimmune hepatitis: A case study and literature review. Can Liver J 2020; 3:381-386. [PMID: 35990507 PMCID: PMC9202740 DOI: 10.3138/canlivj-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 08/05/2023]
Abstract
Rituximab is a monoclonal antibody to CD20, often used to treat B-cell lymphomas and various autoimmune diseases. While there is extensive literature on rituximab-induced liver injury related to hepatitis B reactivation, there have been no reports to date of autoimmune-type idiopathic drug-induced liver injury from this drug. We present a case of necro-inflammatory hepatitis with autoimmune features in a 40-year-old female after receiving a second dose of rituximab for mucosa-associated lymphoid tissue (MALT) lymphoma, with a review of the literature.
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Affiliation(s)
- Polymnia Galiatsatos
- Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sarit Assouline
- Division of Hematology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Adrian Gologan
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nir Hilzenrat
- Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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