Hepatitis B virus infection after renal transplantation in the presence of antibody to hepatitis B surface antigen immunity

Kyun Hwan Kim, Hoon Ahn Sang, Young Chung Hyo, Han Paik Yong, Sik Lee Kwan, Seun Kim Yu, Yoon Chon Chae, Myoung Moon Young, Kwang Hyub Han

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15 Citations (Scopus)

Abstract

Background and Aim: Hepatitis B virus (HBV) infection has been known to be hampered by immunity against hepatitis B surface antigen (HBsAg). However, HBV with mutations within the common antigenic epitope of HBsAg, the 'a' determinant region, can escape from humoral immunity. Moreover, HBV infection by 'a' determinant mutants in chronic HBV patients has been reported after renal transplantation. In the present study, the authors investigated HBV infection after renal transplantation despite passive immunization or resolved HBV infection. Methods: A total of 1682 patients who underwent a renal transplant between 1979 and 1998 at the Severance Hospital, Yonsei University College of Medicine, Korea, were enrolled. The sequence of the HBV genome was analyzed from two patients with antibody to HBsAg (anti-HBs) immunity. Results: Of 1682 patients who were HBsAg negative before transplantation, 21 patients were found to be HBsAg positive, with elevated aspartate aminotransferase and alanine aminotransferase levels after transplantation. Interestingly, six of 21 (28.6%) patients were anti-HBs positive before the transplantation. Sequence analysis of the cloned HBV from two of six patients with anti-HBs immunity showed no evidence of significant mutations within the 'a' determinant region, suggesting a wild-type of HBV. Their donors were not exposed to HBV before transplantation (all HBV markers were negative). Seven deaths of 21 patients were ascribed to HBV-related complications. Conclusions: Regardless of anti-HBs immunity, HBV infection occurred in immunosuppressed patients in a high endemic area. The molecular mechanism and clinical impact of HBV infection after renal transplantation in patients with anti-HBs immunity should be further reappraised.

Original languageEnglish
Pages (from-to)847-853
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume19
Issue number8
DOIs
Publication statusPublished - 2004 Aug

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Virus Diseases
Hepatitis B Surface Antigens
Hepatitis B virus
Kidney Transplantation
Immunity
Antibodies
Transplantation
Mutation
Passive Immunization
Chronic Hepatitis B
Korea
Humoral Immunity
Aspartate Aminotransferases
Alanine Transaminase
Sequence Analysis
Epitopes

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Kim, Kyun Hwan ; Sang, Hoon Ahn ; Hyo, Young Chung ; Yong, Han Paik ; Kwan, Sik Lee ; Yu, Seun Kim ; Chae, Yoon Chon ; Young, Myoung Moon ; Han, Kwang Hyub. / Hepatitis B virus infection after renal transplantation in the presence of antibody to hepatitis B surface antigen immunity. In: Journal of Gastroenterology and Hepatology (Australia). 2004 ; Vol. 19, No. 8. pp. 847-853.
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abstract = "Background and Aim: Hepatitis B virus (HBV) infection has been known to be hampered by immunity against hepatitis B surface antigen (HBsAg). However, HBV with mutations within the common antigenic epitope of HBsAg, the 'a' determinant region, can escape from humoral immunity. Moreover, HBV infection by 'a' determinant mutants in chronic HBV patients has been reported after renal transplantation. In the present study, the authors investigated HBV infection after renal transplantation despite passive immunization or resolved HBV infection. Methods: A total of 1682 patients who underwent a renal transplant between 1979 and 1998 at the Severance Hospital, Yonsei University College of Medicine, Korea, were enrolled. The sequence of the HBV genome was analyzed from two patients with antibody to HBsAg (anti-HBs) immunity. Results: Of 1682 patients who were HBsAg negative before transplantation, 21 patients were found to be HBsAg positive, with elevated aspartate aminotransferase and alanine aminotransferase levels after transplantation. Interestingly, six of 21 (28.6{\%}) patients were anti-HBs positive before the transplantation. Sequence analysis of the cloned HBV from two of six patients with anti-HBs immunity showed no evidence of significant mutations within the 'a' determinant region, suggesting a wild-type of HBV. Their donors were not exposed to HBV before transplantation (all HBV markers were negative). Seven deaths of 21 patients were ascribed to HBV-related complications. Conclusions: Regardless of anti-HBs immunity, HBV infection occurred in immunosuppressed patients in a high endemic area. The molecular mechanism and clinical impact of HBV infection after renal transplantation in patients with anti-HBs immunity should be further reappraised.",
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Hepatitis B virus infection after renal transplantation in the presence of antibody to hepatitis B surface antigen immunity. / Kim, Kyun Hwan; Sang, Hoon Ahn; Hyo, Young Chung; Yong, Han Paik; Kwan, Sik Lee; Yu, Seun Kim; Chae, Yoon Chon; Young, Myoung Moon; Han, Kwang Hyub.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 19, No. 8, 08.2004, p. 847-853.

Research output: Contribution to journalArticle

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T1 - Hepatitis B virus infection after renal transplantation in the presence of antibody to hepatitis B surface antigen immunity

AU - Kim, Kyun Hwan

AU - Sang, Hoon Ahn

AU - Hyo, Young Chung

AU - Yong, Han Paik

AU - Kwan, Sik Lee

AU - Yu, Seun Kim

AU - Chae, Yoon Chon

AU - Young, Myoung Moon

AU - Han, Kwang Hyub

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N2 - Background and Aim: Hepatitis B virus (HBV) infection has been known to be hampered by immunity against hepatitis B surface antigen (HBsAg). However, HBV with mutations within the common antigenic epitope of HBsAg, the 'a' determinant region, can escape from humoral immunity. Moreover, HBV infection by 'a' determinant mutants in chronic HBV patients has been reported after renal transplantation. In the present study, the authors investigated HBV infection after renal transplantation despite passive immunization or resolved HBV infection. Methods: A total of 1682 patients who underwent a renal transplant between 1979 and 1998 at the Severance Hospital, Yonsei University College of Medicine, Korea, were enrolled. The sequence of the HBV genome was analyzed from two patients with antibody to HBsAg (anti-HBs) immunity. Results: Of 1682 patients who were HBsAg negative before transplantation, 21 patients were found to be HBsAg positive, with elevated aspartate aminotransferase and alanine aminotransferase levels after transplantation. Interestingly, six of 21 (28.6%) patients were anti-HBs positive before the transplantation. Sequence analysis of the cloned HBV from two of six patients with anti-HBs immunity showed no evidence of significant mutations within the 'a' determinant region, suggesting a wild-type of HBV. Their donors were not exposed to HBV before transplantation (all HBV markers were negative). Seven deaths of 21 patients were ascribed to HBV-related complications. Conclusions: Regardless of anti-HBs immunity, HBV infection occurred in immunosuppressed patients in a high endemic area. The molecular mechanism and clinical impact of HBV infection after renal transplantation in patients with anti-HBs immunity should be further reappraised.

AB - Background and Aim: Hepatitis B virus (HBV) infection has been known to be hampered by immunity against hepatitis B surface antigen (HBsAg). However, HBV with mutations within the common antigenic epitope of HBsAg, the 'a' determinant region, can escape from humoral immunity. Moreover, HBV infection by 'a' determinant mutants in chronic HBV patients has been reported after renal transplantation. In the present study, the authors investigated HBV infection after renal transplantation despite passive immunization or resolved HBV infection. Methods: A total of 1682 patients who underwent a renal transplant between 1979 and 1998 at the Severance Hospital, Yonsei University College of Medicine, Korea, were enrolled. The sequence of the HBV genome was analyzed from two patients with antibody to HBsAg (anti-HBs) immunity. Results: Of 1682 patients who were HBsAg negative before transplantation, 21 patients were found to be HBsAg positive, with elevated aspartate aminotransferase and alanine aminotransferase levels after transplantation. Interestingly, six of 21 (28.6%) patients were anti-HBs positive before the transplantation. Sequence analysis of the cloned HBV from two of six patients with anti-HBs immunity showed no evidence of significant mutations within the 'a' determinant region, suggesting a wild-type of HBV. Their donors were not exposed to HBV before transplantation (all HBV markers were negative). Seven deaths of 21 patients were ascribed to HBV-related complications. Conclusions: Regardless of anti-HBs immunity, HBV infection occurred in immunosuppressed patients in a high endemic area. The molecular mechanism and clinical impact of HBV infection after renal transplantation in patients with anti-HBs immunity should be further reappraised.

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