Association of Graft Survival with Host Response to Hepatitis B Infection in Patients with Kidney Transplants

Abstract

We studied the relation of host response to hepatitis B infection before transplantation with survival of kidney grafts in 79 patients receiving 87 transplants. Antibody to hepatitis B surface antigen (anti-HBs) signaled early graft rejection (median survival ≈ two months), whereas hepatitis B surface antigen (HBs Ag) signaled delayed rejection (>22 months). Patients with neither HBs Ag nor anti-HBs had graft survival times (median ≈ 16 months) similar to the HBs Ag carriers but significantly longer than the anti-HBs-positive patients (P<0.01). Similar results were observed when patients who received HLA-identical kidneys or had anti-HLA antibodies before transplantation were excluded. The highest probability of graft rejection was in patients with anti-HBs who received kidneys from male donors. The probability that such grafts would survive for four months was <20 per cent. HLA-nonidentical kidneys transplanted into patients with anti-HBs have a poor prognosis, whereas such grafts in HBs Ag carriers have as good a prognosis as grafts in uninfected recipients. (N Engl J Med 296:241–244, 1977) Infection with hepatitis B virus is common in patients undergoing chronic hemodialysis and in patients who have received kidney transplants,12 but whether the infection affects the prognosis of these patients is uncertain.34 To gain information on this point we have tested the hypothesis that there is a relation between the host response to the virus and the host response to a kidney graft. Materials and Methods Patients Since November, 1970, we have obtained monthly blood specimens from patients and staff of a commercial hemodialysis clinic in Philadelphia. Fifty-two of these patients received one or more kidney transplants (60 total) before. © 1977, Massachusetts Medical Society. All rights reserved.