B型肝炎康復的腎移植受贈者B型肝炎病毒再活化的風險因子

研究目的：對於B型肝炎康復的腎移植受贈者，病毒再活化及肝炎發作，可能具有潛在的致命性。我們旨在評估與此情況相關的風險因子。研究方法及資料：研究設計採用回顧性世代研究，在2000年至2020年期間篩選313名B型肝炎康復的腎移植受贈者。排除具干擾因子的個案後，最終納入了257名受試者進行最終分析。根據血清中B型肝炎表面抗原之抗體（anti-HBs）的陽性與否，分別納入了212名和45名患者進入抗體陽性組和陰性組。在調整競爭風險後，分析B型肝炎病毒再活化的累積發生率和亞分佈風險比（subdistribution hazard ratios, SHRs）。研究結果：研究追蹤時間的中位數為8.3年。Anti-HBs陰性組的10年B型肝炎病毒再活化累積發生率顯著高於anti-HBs陽性組（15.2%, 95% CI: 3.6-26.7 vs. 1.3%, 95% CI: 0.0-3.0; p < 0.001).）。多變量回歸分析顯示，缺乏anti-HBs（SHR 14.2, 95% CI: 3.09-65.2; p < 0.001）和使用高劑量類固醇prednisolone每日大於20毫克且超過4週（SHR 9.20, 95% CI: 1.06-79.8; p = 0.044）是與病毒再活化相關的獨立因素。此外，在具有兩個、一個和零個風險因素的患者中，發生B型肝炎病毒再活化的10年累積發生率分別為42.7%（95% CI：0.0-87.1）、7.9%（95% CI：1.2-14.7）和0%（p < 0.001）。結論：在B型肝炎康復的腎移植受贈者，缺乏血清anti-HBs以及使用高劑量類固醇是病毒再活化的獨立風險因素。可以根據風險分層來制定抗病毒預防策略。

Objective：Hepatitis B virus (HBV) reactivation can be potentially life-threatening in kidney transplant recipients with resolved HBV infection. We aimed to evaluate the risk factors related to this condition.Methods and Materials：In this hospital-based retrospective cohort study, consecutive KTRs with resolved HBV infection were screened from the years 2000 through 2020. After excluding confounding conditions, 212 and 45 patients were respectively recruited into Anti-HBs positive and Anti-HBs negative groups. Cumulative incidences of, and subdistribution hazard ratios (SHRs) for HBV reactivation were analyzed after adjusting the competing risk.Results：During a median 8.3 years of follow-up, the 10-year cumulative incidence of HBV reactivation was significantly higher in the anti-HBs negative group when compared to that in the anti-HBs positive group (15.2%, 95% confidence interval [CI]: 3.6-26.7 vs. 1.3%, 95% CI: 0.0-3.0; p < 0.001). In multivariable regression analysis, absence of anti-HBs (SHR 14.2, 95% CI: 3.09-65.2; p < 0.001) and a peak steroid dose ? 20 mg/day of prednisolone equivalent over 4 weeks (SHR 9.20, 95% CI: 1.06-79.8; p = 0.044) were independent factors related to HBV reactivation. Accordingly, the 10-year cumulative incidence of HBV reactivation occurring in patients with two, one and zero risk factors was 42.7% (95% CI: 0.0-87.1), 7.9% (95% CI: 1.2-14.7) and 0%, respectively (p <0.001).Conclusion：In kidney transplant recipients with resolved HBV infection, absence of anti-HBs and use of high-dose steroids were independent risk factors related to HBV reactivation. The strategy of HBV antiviral prophylaxis may be defined according to the risk stratification.