Reply to: “Further evidence of the benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infection”
Authors: Simona Cosconea, Hélène Fontaine, Stanislas Pol
Journal: Journal of Hepatology (2012)

Further evidence of the benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infectionJournal of HepatologyVol. 58Issue 4PreviewWe read with interest about the recent study on the benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus (HBV) infection by Cosconea et al. [1]. We highly appreciate the authors’ results achieved with a specific group of patients with HBV. The authors acknowledged that there is still a lack of data on HBV kidney recipients’ long-term survival. Therefore, we would like to present our results supporting the French group results. The immunosuppressive treatment in patients with chronic HBV infection leads to the loss of immune control of viraemia, hepatitis reactivation, fibrosis progression and hepatocellular carcinoma (HCC) occurrence [2,3]. Full-Text PDF Open AccessBenefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infectionJournal of HepatologyVol. 57Issue 1PreviewHepatitis B virus (HBV) infection is more frequent in kidney recipients than in the general population with a higher rate of liver-related morbidity and mortality. We evaluated the benefit associated with HBV viral suppression by nucleos(t)ide analogues treatment in HBV-infected kidney recipients. Full-Text PDF We read the interesting results of Sperl et al. [[1]Sperl J. Frankova S. Spicak J. Viklicky O. Further evidence of the benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infection.J Hepatol. 2013; 58: 833-835Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar], reporting the benefits associated with analogues treatment of HBV-infected kidney recipients (KR), which corroborate our previous findings [[2]Cosconea S. Fontaine H. Méritet J.F. Corouge M. Sogni P. Vallet-Pichard A. et al.Benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infection.J Hepatol. 2012; 57: 55-60Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar]. A significant increase in graft and patient survival was observed in both our studies, by comparison with series where analogues were either not available [3Pol S. Debure A. Degott C. Carnot F. Legendre C. Brechot C. et al.Chronic hepatitis in kidney allograft recipients.Lancet. 1990; 14: 878-880Google Scholar, 4Mathurin P. Mouquet C. Poynard T. Sylla C. Benalia H. Fretz C. et al.Impact of hepatitis B and C virus on kidney transplantation outcome.Hepatology. 1999; 29: 257-263Crossref PubMed Scopus (498) Google Scholar] or less potent, with viral resistance concerns [[5]Ahn H.J. et al.Clinical outcome of renal transplantation in patients with positive pre-transplant hepatitis B surface antigen.J Med Virol. 2007; 79: 1655-1663Crossref PubMed Scopus (46) Google Scholar].These results are in concordance with the recent updated european guidelines [[6]EASL clinical practice guidelines: management of chronic hepatitis B virus infection.J Hepatol. 2012; 57: 167-185Abstract Full Text Full Text PDF PubMed Scopus (2658) Google Scholar] which recommend HBV screening for all patients with end-stage renal disease, candidates to renal transplantation, and analogue as pre-emptive treatment prior to transplantation, to reduce the risks of HBV reactivation, cirrhosis and hepatocellular carcinoma (HCC).In our study, HCC was responsible for mortality in half of the cases despite an efficient viral suppression in patients with cirrhosis, but with less advanced fibrosis (Metavir F2). This evidences the need of regular ultrasound assessment for HCC early detection, even if a complete viral suppression is fully achieved.We speculate that in the future, the use of potent oral antivirals, which do not enhance the risk of graft rejection in hepatitis C virus (HCV)-infected kidney transplant recipients, will result in the same benefit, given the harmful impact of HCV infection of the liver (cirrhosis and HCC), but also of the renal allograft (de novo glomerulonephritis), on morbidity and mortality.Conflict of interestThe authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. We read the interesting results of Sperl et al. [[1]Sperl J. Frankova S. Spicak J. Viklicky O. Further evidence of the benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infection.J Hepatol. 2013; 58: 833-835Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar], reporting the benefits associated with analogues treatment of HBV-infected kidney recipients (KR), which corroborate our previous findings [[2]Cosconea S. Fontaine H. Méritet J.F. Corouge M. Sogni P. Vallet-Pichard A. et al.Benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infection.J Hepatol. 2012; 57: 55-60Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar]. A significant increase in graft and patient survival was observed in both our studies, by comparison with series where analogues were either not available [3Pol S. Debure A. Degott C. Carnot F. Legendre C. Brechot C. et al.Chronic hepatitis in kidney allograft recipients.Lancet. 1990; 14: 878-880Google Scholar, 4Mathurin P. Mouquet C. Poynard T. Sylla C. Benalia H. Fretz C. et al.Impact of hepatitis B and C virus on kidney transplantation outcome.Hepatology. 1999; 29: 257-263Crossref PubMed Scopus (498) Google Scholar] or less potent, with viral resistance concerns [[5]Ahn H.J. et al.Clinical outcome of renal transplantation in patients with positive pre-transplant hepatitis B surface antigen.J Med Virol. 2007; 79: 1655-1663Crossref PubMed Scopus (46) Google Scholar]. These results are in concordance with the recent updated european guidelines [[6]EASL clinical practice guidelines: management of chronic hepatitis B virus infection.J Hepatol. 2012; 57: 167-185Abstract Full Text Full Text PDF PubMed Scopus (2658) Google Scholar] which recommend HBV screening for all patients with end-stage renal disease, candidates to renal transplantation, and analogue as pre-emptive treatment prior to transplantation, to reduce the risks of HBV reactivation, cirrhosis and hepatocellular carcinoma (HCC). In our study, HCC was responsible for mortality in half of the cases despite an efficient viral suppression in patients with cirrhosis, but with less advanced fibrosis (Metavir F2). This evidences the need of regular ultrasound assessment for HCC early detection, even if a complete viral suppression is fully achieved. We speculate that in the future, the use of potent oral antivirals, which do not enhance the risk of graft rejection in hepatitis C virus (HCV)-infected kidney transplant recipients, will result in the same benefit, given the harmful impact of HCV infection of the liver (cirrhosis and HCC), but also of the renal allograft (de novo glomerulonephritis), on morbidity and mortality. Conflict of interestThe authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.