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Association of Graft Survival with Host Response to Hepatitis B Infection in Patients with Kidney Transplants
Journal article   Peer reviewed

Association of Graft Survival with Host Response to Hepatitis B Infection in Patients with Kidney Transplants

W. Thomas London, Jean S Drew, Baruch S Blumberg, Robert A Grossman and Patricia J Lyons
The New England journal of medicine, v 296(5), pp 241-244
03 Feb 1977
PMID: 318732

Abstract

We studied the relation of host response to hepatitis B infection before transplantation with survival of kidney grafts in 79 patients receiving 87 transplants. Antibody to hepatitis B surface antigen (anti-HB s ) signaled early graft rejection (median survival ≈ two months), whereas hepatitis B surface antigen (HB s Ag) signaled delayed rejection (>22 months). Patients with neither HB s Ag nor anti-HB s had graft survival times (median ≈ 16 months) similar to the HB s Ag carriers but significantly longer than the anti-HB s -positive patients (P<0.01). Similar results were observed when patients who received HLA-identical kidneys or had anti-HLA antibodies before transplantation were excluded. The highest probability of graft rejection was in patients with anti-HB s who received kidneys from male donors. The probability that such grafts would survive for four months was <20 per cent. HLA-nonidentical kidneys transplanted into patients with anti-HB s have a poor prognosis, whereas such grafts in HB s Ag carriers have as good a prognosis as grafts in uninfected recipients. (N Engl J Med 296:241–244, 1977) Infection with hepatitis B virus is common in patients undergoing chronic hemodialysis and in patients who have received kidney transplants, 1 , 2 but whether the infection affects the prognosis of these patients is uncertain. 3 , 4 To gain information on this point we have tested the hypothesis that there is a relation between the host response to the virus and the host response to a kidney graft. Materials and Methods Patients Since November, 1970, we have obtained monthly blood specimens from patients and staff of a commercial hemodialysis clinic in Philadelphia. Fifty-two of these patients received one or more kidney transplants (60 total) before . . .

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