Outcome of kidney transplant recipients with a history of hepatitis B and C viruses

A single-center cohort study.

Abstract

Introducción: Kidney transplantation (KT) in patients with viral hepatitis (HBV and HCV) represents a significant challenge, given its high prevalence and its contribution to important posttransplant complications. The objective of this study is to evaluate the posttransplant evolution of patients who were treated and cured of hepatitis B or C before receiving the transplant.

Methods: We conducted a retrospective study at the Ibn Sina University Hospital, Rabat, over 35 years (1983–2018). The study included 20 kidney transplant recipients with cured HBV or HCV before transplantation. Patients were divided into two groups: Group A (no viral reactivation) and Group B (viral reactivation). Various factors, including demographic, clinical, immunosuppressive, and virological parameters, were analyzed.

Results: Of the 20 patients, 16 had cured HCV and 4 had cured HBV. The median age at transplantation was 38.5 years. Among the 8 patients with HCV reactivation, only one had received direct-acting antiviral treatment and achieved a sustained virological response. HBV reactivation occurred in 3 patients, leading to graft rejection in 2. Reactivation of either virus was associated with proteinuria, graft rejection, and return to dialysis. The overall mortality rate was 15%, with two deaths linked to viral reactivation.

Conclusions: Kidney transplant recipients with a history of HBV or HCV face increased risks of graft rejection, proteinuria, and graft loss. Viral reactivation is associated with poor outcomes, underscoring the importance of pretransplant antiviral treatment in improving graft survival. Although viral hepatitis prevalence has decreased due to improved hygiene and vaccination, these infections remain a significant risk factor for kidney graft failure.