Impact of HBs antigenemia on long‐term patient survival and causes of death after renal transplantation

The impact of hepatitis B virus in renal transplantation remains a controversial subject. To evaluate the long‐term consequences of chronic HBs antigenemia on patient survival, we studied 615 consecutive patients who received a kidney transplant in a single center from 1970 to 1984, including 107 HBs Ag‐positive, and 508 HBs Ag‐negative patients. Pretransplant HBs Ag‐negative patients had a significantly better long‐term survival rate (80% vs 64% survival in HBs Ag‐positive patients at 10 years posttransplant, p<0.05). This difference was strongest in the subgroup of patients who had a functional graft at 3 months posttransplant (81% vs 60% at 10 yr, p<0.001), and in the subgroup of patients whose graft never failed (71% vs 53%). The overall mortality incidence was more important in pretransplant HBs Ag‐positive patients (34.4% vs 20.5% in HBs Ag‐negative patients, p<0.001), and liver failure was the main cause of death in the HBs Ag‐positive group after the 5th yr posttransplant (30% vs 4.2% in HBs Ag‐negative patients, p<0.05). Pretransplant serum transaminases did not predict posttransplant hepatic failure or death. Finally, the impact of HBs antigenemia was only seen in patients over 40 yr old at the time of transplant (50% vs 69% at 10 yr, p<0.01), and in patients receiving conventional drugs. We conclude that HBs Ag‐positive patients had an obvious moderately increased risk of mortality with renal transplantation, seen over the long term (16% at 10 yr). We recommend that candidates for renal transplantation should not be excluded from the procedure, but must be submitted to a careful pretransplant check‐up, and to routine liver monitoring if renal transplantation is to be performed.