Clinical

Antiviral therapy improves renal transplantation outcome in hepatitis B patients

Last Updated: 2007-11-22 8:45:09 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - With antiviral therapy, renal transplantation can be successful in hepatitis B surface antigen (HBsAg)-positive patients with end-stage renal disease, according to a report in the November issue of the Journal of Medical Virology.

"In the era of liberal use of lamivudine or other anti-hepatitis B virus agents, renal transplantation in HBsAg-positive end-stage renal disease patients should be encouraged when performed under careful monitoring of viral titer and cautious use of immunosuppressive drugs by experts," Dr. Yu Seun Kim from Yonsei University Medical Center, Seoul, Korea told Reuters Health.

Dr. Kim and colleagues retrospectively examined the clinical outcomes of 2054 renal transplant recipients from 1979-2004, including 66 patient who were HBsAg-positive before their transplantation.

Overall, 10-year survival rates were 88.2% in the HBsAg-negative control group and 64.4% in the HBsAg-positive study group, the report indicates, and the 10-year death-censored graft survival rates were 79.7% in the control group and 56.9% in the study group.

"Since 1997, lamivudine was used when hepatitis B PCR was positive or when the level of post-transplant viral load rose," the team notes.

Among 27 HBsAg-positive patients treated with lamivudine, all but three showed a response, the investigators say. Fifteen patients had complete virological responses, and six showed partial virological responses to antiviral therapy.

Lamivudine improved 10-year survival in these 27 patients compared with HBsAg-positive patients not given lamivudine (85.3% vs. 49.9%), Dr. Kim and colleagues report.

Viral breakthrough occurred in 13 of the 24 initial responders to lamivudine therapy. In three cases, adefovir rescue induced virological responses and restored liver function. In the other 10 cases, six remained alive with elevated liver enzymes.

"The continuous use of lamivudine may be effective even in the cases that show viral breakthrough," Dr. Kim said. "However, careful discontinuation of lamivudine therapy could be considered in patients with stable hepatic function and sustained negative viremia."

In conclusion, the researchers write, "In the era of lamivudine and adefovir, renal transplantation in HBsAg-positive end-stage renal disease patients should not be abandoned."

J Med Virol 2007;79:1655-1663.