Clinical Outcome of Renal Transplantation in Patients with Positive Pretransplant Hepatitis B Surface Antigen / 대한이식학회지

PURPOSE: The natural history of renal transplant recipients with positive HBs Ag is still unclear and unpredictable. Liver-related morbidity and mortality after long-term immunosuppression need clinical challenges. We retrospectively investigated the clinical outcome of pre-transplant HBs Ag positive renal recipients in a single transplant center located in endemic area. METHODS: After excluding post-transplant de novo HBV infected, and peri-transplant anti-hepatitis C virus positive recipients, the clinical outcome of 1,816 recipients was examined by the nature of pre-transplant HBs Ag positivity. RESULTS: Pre-transplant HBs Ag positivity was documented in 61 recipients (M/F=47/14). During mean follow up of 71.61+/-54.14 months, 24 recipients died (6 by infection, 12 by hepatic failure, 2 by hepatocellular carcinoma, 2 by other malignancies, 1 by suicide, 1 by gastrointestinal bleeding). In 14 recipients (58.3%), death was related to liver-associated reasons. The 10-year patient survival rates in HBs Ag negative and positive groups were 90.0% and 62.6%, respectively (P<0.0001). The 10-year graft survival rates in HBs Ag negative and positive groups were 82.0% and 55.6%, respectively (P<0.0001). When pre-transplant HBV DNA viral load by PCR was positive or when the level of post-transplant HBV-DNA viral load flared up, we started lamivudine therapy since 1997. Seventeen recipients received daily 100 mg lamivudine. The mean duration of patients survival with (n=17) and without (n=44) lamivudine therapy was 104.3+/-45.6 and 59.0+/-51.2 months, respectively (P= 0.003). The 10-year patient survival rates in patients with and without lamivudine therapy were 80.7% and 55.4%, respectively (P=0.0698). CONCLUSION: Overall patient and graft survival in patients with positive pre-transplant HBs Ag was lower than negative recipients. Although, statistically not significant, lamivudine therapy showed a marginally positive impact on the survival of patients with pre-transplant positive HBs Ag.

Evaluation of Serologic Marker Tests for Hepatitis B Viral Infection Using the Automated Immunoassay System ARCHITECT i2000 / 대한임상병리학회지

BACKGROUND: The prevalence of Hepatitis B virus (HBV) in Korea is still higher than that of devel-oped countries. Recently, the automated chemiluminescent microparticle immunoassay analyzer ARCHITECT i2000 (Abbott Laboratories, Abbott Park, IL USA) was introduced in Korea and we evaluated performance of the tests for serological markers for HBV infection. METHODS: We analyzed precision, agreement, sensitivity, specificity and throughput of the HBs antigen, anti-HBs and anti-HBc as well as linearity and compared with the AxSYM (Abbott Labora-tories, Abbott Park, IL USA) for anti-HBs. Precision, linearity and comparison were performed on the basis of the National Committee for Clinical Laboratory Standards guidelines. Random patients 'sera were used for this study. RESULTS: The coefficients of variations of precision were below 5% for anti-HBs and anti-HBc (total) except for the HBs antigen. The agreements, sensitivities and specificities for serologic mark-ers were more than 90%. The linearity and comparison for anti-HBs were statistically significant (P < 0.001). The throughput of ARCHITECT i2000 was 110 tests/hours and that was 2.8 times faster than that of the AxSYM. CONCLUSIONS: These results suggest that ARCHITECT i2000 can provide rapid and effective results for serologic markers for HBV infection. However, each laboratory should decide the utiliza-tion of this analyzer on the basis of volume of samples, other items tested concurrently, and the inter-face of existing facilities etc.