Dissertação de mestrado
Evolução dos pacientes submetidos a transplante renal com infecção crônica ou pregressa pelo vírus da Hepatite B
Fecha
2021Autor
Leopercio, Ana Paula Serra [UNIFESP]
Institución
Resumen
Chronic hepatitis B virus (HBV) infection has a high prevalence among patients with advanced renal disease stage in relation to the general population, and previous HBV infection is common among kidney transplant recipients, with rates ranging from 2.2% to 20.9%. The presence of the virus in this group of patients is associated with increased morbidity, mortality, loss of renal graft, besides the risk of reactivation after transplantation. Objective: This study aimed to evaluate patients undergoing kidney transplantation from January 1993 to December 2012 with chronic infection or previous contact with HBV seeking to verify clinical outcomes: reactivation of HBV, liver decompensation, loss of graft, hepatocellular carcinoma, liver transplantation and death. Impact of co-infection with HCV on outcomes and antiviral therapy for HBV. Results: From a total of 10,493 transplants performed in the period, 203 patients were included. The mean age was 40.2±1.2 years and 66% were male. Viral recurrence occurred in 19.6% of HBsAg+ versus anti-HBcT+ patients (9.8%). Being on pre-reactivation prophylactic antiviral treatment was the only variable that was associated with a lower occurrence of reactivation.As for the final outcome, after an average follow-up period of 11.3±5.6 years, 19.2% resulted in renal graft rejection, 4.4% in liver decompensation and death in 23% of cases. The presence of anti-HCV was associated with a greater risk of kidney graft loss. The occurrence of hepatic decompensation was uncommon and most deaths were not related to the liver cause. Finally, patient and renal graft survival was lower in HBsAg + patients when compared to anti-HBcT +. Conclusion: This study allowed us to conclude that being on pre-reactivation prophylactic antiviral treatment was the only variable that was associated with a lower occurrence of reactivation. The presence of anti-HCV correlated with a higher risk of kidney graft loss. The occurrence of hepatic decompensation was uncommon and most deaths were not due to hepatic causes. Finally, patient and renal graft survival was lower in HBsAg+ patients when compared to anti-HBcT+ patients. A Infecção crônica pelo vírus da hepatite B (HBV) tem elevada prevalência entre pacientes com doença renal crônica e a infecção prévia pelo HBV é comum entre os receptores de transplante de rim, com taxas que variam de 2,2% a 20,9%. A presença do vírus nesse grupo de pacientes está associada ao aumento de morbidade, mortalidade, perda do enxerto renal, além do risco de reativação após o transplante. Objetivo: O presente estudo objetivou avaliar os pacientes submetidos a transplante de rim de janeiro de 1993 a dezembro de 2012 com infecção crônica ou contato prévio pelo HBV procurando verificar os seguintes desfechos: reativação do HBV, descompensação hepática, perda do enxerto, carcinoma hepatocelular, transplante hepático e óbito, além do impacto de coinfecção com HCV nos desfechos e da terapia antiviral para HBV. Resultados: Foram realizados 10.493 transplantes no período, sendo inclusos 203 pacientes. A média de idade foi de 40,2±1,2 anos e 66% eram do sexo masculino. A recorrência viral ocorreu em 24,6% nos pacientes HBsAg+ versus anti-HBcT+ (9,8%). Quanto ao desfecho final, após período médio de acompanhamento de 11,3±5,6 anos, 19,2% resultaram em rejeição do enxerto renal, 4,4% em descompensação hepática e óbito em 23% dos casos. Conclusão: Esse estudo permitiu concluir que estar em tratamento profilático antiviral pré-reativação foi a única variável que se associou à menor ocorrência de reativação. A presença de anti-HCV se correlacionou com o maior risco para perda do enxerto de rim. A ocorrência de descompensação hepática foi pouco comum e a maior parte dos óbitos não foi por causa hepática. Por fim, a sobrevida dos pacientes e do enxerto renal foi menor nos pacientes HBsAg+ quando comparados aos pacientes anti-HBcT+.