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

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 200mg/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 1-3 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 (anti-HBs) preoperatively. HBV reactivation was not found in 6 patients lacking anti-HBs preoperatively. Conclusions: Low-dose RIT administration in kidney transplant patients without prophylaxis is associated with low incidence of HBV reactivation. However, the comparisons amongst standard-dose RIT, low-dose RIT, and controls with high quality study design is necessary. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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