Prevention of Hepatitis B Virus Reactivation in Kidney Transplant Recipients

BACKGROUND AND OBJECTIVE: Hepatitis B virus (HBV) reactivation is a major risk factor for hepatic dysfunction, acute or chronic hepatitis, cirrhosis, or hepatocellular carcinoma after kidney transplantation (KTP). The present article summarizes some of published articles about prevention of HBV reactivation in renal transplant recipients METHODS: Many articles published in English language as full-text manuscripts reviewed in a variety of sources such as Scopus, Pub Med and Google Scholar with key words of hepatitis B and kidney transplantation to collect current data about this issue. FINDINGS: The risk of reactivation of HBV followingKTP is related to the status of serologic markers of HBV at the time of KTP.KTP candidate patients who are hepatitis B surface antigen (HBsAg) positivehave higher risk for reactivation especially those who are hepatitis B e antibody positive or have high levels of HBV DNA in serum. Lamivudine has been most extensively used for prevention of HBV reactivation, but it is associated with a high rate of drug resistance.It seems that the optimal antiviral agent for prevention of HBV reactivation is entecavir which is associated with the lowest risk of drug resistance,however lamivudine-resistant HBV is less sensitive to entecavir. The preferred antiviral agent for lamivudine-resistant HBV is tenofovir which should be added to lamivudine rather than stopping lamivudine. It is reported that combination therapy in this sitting may reduce the development of resistance to the second drug. CONCLUSION: There is sufficient evidence to recommend routine antiviral prophylaxis for all HBsAg-positive patients who are undergoing kidney transplantation

Restless Legs Syndrome: Associated Risk Factors in Hemodialysis Patients

BACKGROUND: Restless legs syndrome (RLS) may be associated with increased morbidity and mortality among end-stage renal disease (ESRD) patients; however, it is a disorder that is neglected in dialysis centers. OBJECTIVES: The goal of this study was to investigate the clinical factors associated with RLS among ESRD patients. PATIENTS AND METHODS: This cross-sectional study was conducted on ESRD patients undergoing maintenance hemodialysis (HD) in three HD centers in Ahvaz city in Southwest Iran. Blood samples were obtained prior to a dialysis session to check the routine laboratory test results and assess the adequacy of dialysis. The presence of RLS was assessed by using the international RLS study group (IRLSSG) diagnostic criteria. The IRLSSG rating scale was also used to evaluate the severity of the RLS symptoms. RESULTS: Of the 139 HD patients enrolled in this study, 60 were female (43.2%) and 79 were male (56.8%), with a mean age of 51.82 ± 13.31 years. The prevalence of RLS was 15.8% (22 patients), with 50% of them (11 patients) having severe or very severe symptoms. There was a significant relationship between RLS and longer durations of dialysis (P < 0.001). The mean level of serum ferritin was lower in patients without RLS, but it was not significant (P = 0.065). No significant differences were found according to age, gender, dialysis shifts, and hemoglobin (Hb) level among patients with and without RLS. CONCLUSIONS: We conclude that a significant percentage of ESRD patients undergoing maintenance HD have severe or very severe RLS symptoms. The presence of RLS is associated to longer durations of dialysis