Schwarz Chloë, Morel Antoine, Matignon Marie, Grimbert Philippe, Rondeau Eric, Ouali Nacera, François Hélène, Mesnard Laurent, Petit-Hoang Camille, Rafat Cédric, Dahan Karine, Luque Yosu
Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
Service de Néphrologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Kidney Int Rep. 2023 May 16;8(8):1531-1541. doi: 10.1016/j.ekir.2023.05.005. eCollection 2023 Aug.
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.
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.
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 ( = 0.363); and 5-year graft survival of 100% (28.6; 100) and 79.8% (61.7; 100), respectively ( = 0.335). No factor, including HBsAb positivity and antiviral prophylaxis, was statistically associated with the risk of HBV reactivation.
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.
据报道，在抗乙肝核心抗体（HBcAb）阳性、乙肝表面抗原（HBsAg）阴性的肾移植受者中，乙肝病毒（HBV）再激活的发生率为3%至9%。对于接受选择性共刺激阻断剂贝拉西普治疗的患者，尚未有相关研究。
我们对法国两个肾脏移植中心所有接受贝拉西普治疗的移植受者进行了一项回顾性研究。在HBcAb阳性患者中，我们分析了HBV再激活率、预后及危险因素。
共纳入135例接受贝拉西普治疗的患者，其中32例HBcAb阳性，2例HBsAg阳性。7例患者出现HBV再激活（占HBcAb阳性患者的21.9%），其中5例HBsAg阴性患者（占HBcAb阳性、HBsAg阴性患者的16.7%）。再激活发生在移植后54.8（±70.9）个月。1例患者出现严重肝炎，1例患者发展为肝硬化。HBV再激活患者与未再激活患者的生存率无显著差异：5年患者生存率分别为100%（28.6；100）和83.4%（67.6；100）（P = 0.363）；5年移植物生存率分别为100%（28.6；100）和79.8%（61.7；100）（P = 0.335）。包括乙肝表面抗体（HBsAb）阳性和抗病毒预防在内的任何因素与HBV再激活风险均无统计学关联。
与既往移植研究相比，接受贝拉西普治疗的患者HBV再激活率较高。HBV再激活不影响生存率。需要进一步研究以证实这些结果。应考虑并评估对这些患者进行系统性抗病毒预防。
