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HBV and Transplantation — ESENeph MCQ

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ModerateTransplantationHBV and TransplantationESENeph

A 62-year-old man on haemodialysis has hepatitis B (HBsAg positive, HBV DNA detectable). He is being treated with Entecavir. He is being worked up for kidney transplant. What is the key concern regarding HBV and transplantation?

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Correct answer: E — Post-transplant immunosuppression may cause HBV reactivation; antiviral prophylaxis is essential

HBsAg-positive patients can receive kidney transplants but require lifelong antiviral prophylaxis/treatment because post-transplant immunosuppression increases HBV replication risk. KDIGO 2009 transplant guideline recommends continuing antiviral therapy indefinitely post-transplant. Entecavir or TAF are preferred agents (TAF preferred if CKD concerns exist). HBV DNA and liver function should be monitored regularly. HBV reactivation can cause severe hepatitis and graft loss. HBsAg-positive status is NOT a contraindication to transplantation.

Reference: KDIGO 2009 – Transplant Guideline; EASL 2024 – HBV Guidelines