A survey on the prevalence and management of hepatitis B after renal transplantation in Asian-Pacific countries
2004
The carrier rate for hepatitis B virus (HBV) varies from 1% to 2% to 10% in Asian-Pacific countries. A survey involving 12 transplant centers from 11 countries in this region showed that 1% to 25% of
kidney transplantrecipients were infected with HBV, and up to 60% of these subjects showed abnormal liver biochemistry. While nearly all centers tested anti-HBs in potential
kidney transplantrecipients, HBV vaccination of nonimmune subjects was routine in only 66.7%. One-third of the surveyed units rejected
HBsAg-positive subjects as kidney donors, while the others demonstrated differing policies in choosing the respective recipients. Two units (16.7%) excluded
HBsAg-positive patients from
kidney transplantation, whereas the others only excluded those with severe liver disease. Heterogeneity also applies to the immunosuppressive regimens, the use of HBV DNA in serial monitoring, and the timing of antiviral therapy in
HBsAg-positive
kidney transplantrecipients. The data showed that despite HBV infection being a significant problem in
kidney transplantation, there is a lack of uniform management policy, attributable to the clinical complexity and deficiency of research data. Although improvement in clinical outcome is likely with the advent of
nucleoside analoguetherapy and better monitoring, the financial implications in the adoption of these recent advances remain realistic concerns.
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