Effect of Lamivudine Treatment in Renal Transplant Recipient with HBsAg-Positivity.
- Author:
Sang Woo HAN
1
;
Jin Young KIM
;
Su Hyun KIM
;
Bum Soon CHOI
;
Cheol Whee PARK
;
Chul Woo YANG
;
Yong Soo KIM
;
Suk Young KIM
;
Yoon Sik CHANG
;
Byung Kee BANG
Author Information
1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. nephron@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Renal transplantation;
Hepatitis B virus;
Lamivudine
- MeSH:
Carcinoma, Hepatocellular;
Follow-Up Studies;
Hepatitis;
Hepatitis B virus;
Hepatitis B, Chronic;
Humans;
Kidney Transplantation;
Lamivudine*;
Liver;
Liver Failure, Acute;
Mortality;
Salvage Therapy;
Transplantation*
- From:Korean Journal of Nephrology
2006;25(6):999-1006
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND:Immunosuppressive therapy after renal transplantation stimulates the replication of hepatitis B virus (HBV) and may lead to increased liver-related mortality. We investigated the effectiveness of lamivudine for the treatment of HBV reactivation in renal transplant recipients. METHODS:We reviewed the clinical course of 16 HBsAg-positive renal transplant patients (M:F=13:3) treated with lamivudine for chronic hepatitis B. The outcome of prophylactic (HBV-DNA negative, n=5) and preemptive (HBV-DNA positive, n=4) therapy without hepatic dysfunction was analyzed in compared with that of salvage (n=7) therapy for post-transplantation hepatic dysfunction. RESULTS:Chronic hepatitis developed in four (25 %) of the enrolled 16 recipients, including one fulminant hepatic failure in prophylactic group and one hepatocellular carcinoma in the salvage group. We found that three (33%) of 9 patients under prophylactic and preemptive therapy showed post-transplantation hepatic dysfunction, but that only one (14%) of 7 patients showed elevated liver enzyme after salvage therapy. During a mean follow-up, under prophylactic and preemptive therapy, of 38 months, five (56%) of 9 patients showed resistance to lamivudine. In seven patients under salvage therapy for a mean follow-up of 26 months, only one patient (14%) showed resistance. At the last follow-up, liver enzyme levels were normal in 14 patients (87.5%). CONCLUSION:It may be beneficial to use lamivudine for the prevention of liver-related mortality in renal transplant recipients with HBs-Ag positivity. Prophylactic and preemptive lamivudine therapy tend to show higher viral resistance compared with salvage therapy.
