LAUSR

Background The American Gastroenterological Association and European Association for the Study of the Liver recommend that hepatitis B surface antigen (HBsAg)–negative and hepatitis B core antibody (anti-HBc)–positive patients who receive immunosuppression should be monitored for hepatitis B virus (HBV) infection regardless of hepatitis B surface antibody (anti-HBs) status. However, anti-HBs may provide protection against infection. To investigate whether the presence of anti-HBs in addition to anti-HBc confers protection, we classified HBsAg(−) kidney transplantation (KT) patients into 4 groups according to anti-HBc and anti-HBs status, and compared the HBV infection rate between the anti-HBc(+)anti-HBs(+) group and the other 3 groups. Methods In this single-center retrospective study, we classified 1959 patients into 4 groups: anti-HBc(−)anti-HBs(−) (n = 356), anti-HBc(−)anti-HBs(+) (n = 652), anti-HBc(+)anti-HBs(−) (n = 142), and anti-HBc(+)anti-HBs(+) (n = 809). Results Hepatitis B virus infection was noted in 31 (1.6%) patients after KT. There was a significant difference in HBV infection rate between anti-HBc(+)anti-HBs(+) (1.2%) and anti-HBc(+)anti-HBs(−) (5.6%) (P < 0.001), but not between anti-HBc(+)anti-HBs(+) and anti-HBc(−)anti-HBs(−) (1.1%) or anti-HBc(−)anti-HBs(+) (1.4%). There was a significant difference in HBV infection rate according to anti-HBs titer, but no difference according to the donor viral profile. Hepatic failure occurred in 1 anti-HBc(+)anti-HBs(−) patient and 1 anti-HBc(+)anti-HBs(+) patient, both of whom died. Hepatocellular carcinoma was noted in 4 anti-HBc(−) patients, but not in anti-HBc(+) patients. Conclusions The presence of anti-HBs confers protection against HBV infection. We recommend monitoring for HBV infection after KT in HBsAg(−) anti-HBc(+) anti-HBs(−) patients, but not in HBsAg(−) anti-HBc(+) anti-HBs(+) patients.