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KMID : 0359920060250060999
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Korean Journal of Nephrology
2006 Volume.25 No. 6 p.999 ~ p.1006
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Effect of Lamivudine Treatment in Renal Transplant Recipient with HBsAg-Positivity
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Han Sang-Woo
Kim Jin-Young
Kim Su-Hyun
Choi Bum-Soon
Park Cheol-Whee
Yang Chul-Woo
Kim Yong-Soo
Kim Suk-Young
Chang Yoon-Sik
Bang Byung-Kee
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Abstract
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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. (Korean J Nephrol 2006;25(6):999-1006)
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KEYWORD
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Renal transplantation, Hepatitis B virus, Lamivudine
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