Paschereit Anissa, Greese Vivien, Sakurayama Kayo, Duerr Michael, Halleck Fabian, Liefeldt Lutz, Choi Mira, Budde Klemens, Naik Marcel G
Department of Nephrology and Medical Intensive Care, Charité-Berlin University Medicine, Charitéplatz 1, 10117 Berlin, Germany.
Boehringer Ingelheim, Friedrichstraße 70, 10117 Berlin, Germany.
J Clin Med. 2025 Mar 20;14(6):2124. doi: 10.3390/jcm14062124.
: Chronic Hepatitis B virus (HBV) infection is a significant global health issue, with dialysis patients at increased risk and reduced response to HBV vaccination. The effects of HBV serological status on kidney transplant outcomes, particularly for patients with resolved or inactive HBV infection, needs more data, especially from current era. This study evaluated the impact of chronic and non-active HBV infection on patient and graft survival after kidney transplantation. : Retrospective analysis was conducted of kidney-only transplant recipients at our center from 1 January 1990 to 31 August 2019 (end of observation). Patients were grouped by their HBV serostatus before transplantation into three categories: HBV negative (HBsAg-/Anti-Hbc-), non-active HBV infection (HbsAg-/Anti-Hbc+) and chronic HBV infection (HbsAg+/Anti-Hbc+). Primary outcomes included patient survival, graft survival, and overall graft and patient survival, analyzed using Kaplan-Meier (KM) curves, log-rank tests, Restricted mean survival times (RMST), and Accelerated failure time (AFT) models. : Among 2490 patients, 2197 were HBV negative, 218 had non-active HBV, and 75 had chronic HBV. Over a mean follow-up of 8.1 years, mortality and graft failure rates were highest in chronic HBV patients (49% and 37%), followed by non-active HBV (39% and 29%) and HBV-negative patients (30% and 20%). KM analysis revealed significantly lower overall survival rates for chronic HBV and non-active HBV groups compared to HBV-negative patients ( = 0.006). RMST confirmed significant reductions in survival for the non-active group (12.57 vs. 14.17 years, = 0.007). Cox regression and AFT models identified older recipient/donor age, Hepatitis-C-virus coinfection, and broad antigen mismatches as negative predictors, while living donors improved outcomes. : While unadjusted Kaplan-Meier curves and RMST analysis suggested differences in patient and graft survival, further thorough multivariable AFT analysis did not show a significant association between non-active or chronic HBV infection and patient or graft survival after kidney transplantation.
慢性乙型肝炎病毒（HBV）感染是一个重大的全球健康问题，透析患者感染风险增加且对HBV疫苗接种的反应降低。HBV血清学状态对肾移植结果的影响，特别是对于已治愈或非活动性HBV感染的患者，需要更多数据，尤其是来自当前时代的数据。本研究评估了慢性和非活动性HBV感染对肾移植后患者和移植物存活的影响。：对1990年1月1日至2019年8月31日（观察结束）在本中心仅接受肾移植的受者进行回顾性分析。患者在移植前根据其HBV血清学状态分为三类：HBV阴性（HBsAg-/Anti-Hbc-）、非活动性HBV感染（HbsAg-/Anti-Hbc+）和慢性HBV感染（HbsAg+/Anti-Hbc+）。主要结局包括患者存活、移植物存活以及总体移植物和患者存活，使用Kaplan-Meier（KM）曲线、对数秩检验、受限平均生存时间（RMST）和加速失效时间（AFT）模型进行分析。：在2490例患者中，2197例为HBV阴性，218例为非活动性HBV感染，75例为慢性HBV感染。平均随访8.1年，慢性HBV患者的死亡率和移植物失败率最高（分别为49%和37%），其次是非活动性HBV患者（分别为39%和29%）以及HBV阴性患者（分别为30%和20%）。KM分析显示，与HBV阴性患者相比，慢性HBV和非活动性HBV组的总体生存率显著较低（P = 0.006）。RMST证实非活动性组的生存期显著缩短（12.57年对14.17年，P = 0.007）。Cox回归和AFT模型确定受者/供者年龄较大、丙型肝炎病毒合并感染以及广泛的抗原错配为阴性预测因素，而活体供者可改善结局。：虽然未调整的Kaplan-Meier曲线和RMST分析表明患者和移植物存活存在差异，但进一步深入的多变量AFT分析并未显示非活动性或慢性HBV感染与肾移植后患者或移植物存活之间存在显著关联。
