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Management of Chronic Hepatitis B in Special Populations: Immunosuppressed Patients and Chronic Kidney Disease

  • Hepatitis B: Epidemiology, Natural History, Treatment, and Transplantation (Thomas Berg and Steven-Huy Han, Section Editors)
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Abstract

Hepatitis B virus (HBV) infection remains an important cause of liver disease in the population with chronic kidney disease, including patients on long-term dialysis and renal transplant (RT) recipients. Diminished survival due to hepatitis B has been observed after RT. A thorough evaluation, including liver biopsy as well as assessment of serum markers of HBV replication (ie, hepatitis B e antigen and/or HBV DNA) is required before transplantation. Tolerance to interferon is poor both in dialysis patients and after renal transplant. Oral antiviral therapy now permits safe and potent antiviral treatment of HBV-related liver disease in chronic kidney disease patients with prevention of progressive liver disease. Preliminary evidence shows an improved survival of HBsAg positive renal allograft recipients on antiviral therapy. However, numerous issues concerning the treatment of hepatitis B in the population with chronic kidney disease remain unclear and further clinical trials are needed.

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Acknowledgements

This work has been supported in part by the Project Glomerulonephritis grant, in memory of Pippo Neglia.

Disclosure

Paul Martin has been a board member for BMS and a consultant for Gilead, and has received grants, honoraria, payment for development of educational presentations, and travel and accommodation expense reimbursement from BMS and Gilead; Fabrizio Fabrizi, Vivek Dixit and Piergiorgio Messa reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Milan, Italy

    Fabrizio Fabrizi & Piergiorgio Messa

  2. Division of Hepatology, School of Medicine, University of Miami, Miami, FL, USA

    Fabrizio Fabrizi, Vivek Dixit & Paul Martin

  3. Divisione Nefrologica, Ospedale Maggiore, Pad. Croff, Via Commenda 15, 20122, Milan, Italy

    Fabrizio Fabrizi

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  1. Fabrizio Fabrizi
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  2. Vivek Dixit
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  4. Paul Martin
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Correspondence to Fabrizio Fabrizi.

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Fabrizi, F., Dixit, V., Messa, P. et al. Management of Chronic Hepatitis B in Special Populations: Immunosuppressed Patients and Chronic Kidney Disease. Curr Hepatitis Rep 10, 269–276 (2011). https://doi.org/10.1007/s11901-011-0116-0

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