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Clinical outcome of renal transplantation in patients with positive pre‐transplant hepatitis B surface antigen
Author(s) -
Ahn Hyung Joon,
Kim Myoung Soo,
Kim Yu Seun,
Kim Soon Il,
Huh Kyu Ha,
Ju Man Ki,
Ahn Sang Hoon,
Han KwangHyub
Publication year - 2007
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.20980
Subject(s) - lamivudine , adefovir , hbsag , medicine , gastroenterology , transplantation , hepatitis b virus , hepatitis b , liver transplantation , immunology , virus
The clinical outcomes of 2,054 renal recipients were examined retrospectively based on pre‐transplant hepatitis B surface antigen (HBsAg) status to investigate the efficacy of lamivudine treatment in HBsAg positive recipients. Pre‐transplant HBsAg positivity was documented in 66 recipients. The 10‐year patient and graft survival rates in Ag positive group were significantly lower than those of Ag negative group (64.4/36.6% vs. 88.2/70.5%, respectively, P < 0.0001). Since 1997, lamivudine was used when hepatitis B virus polymerase chain reaction (HBV PCR) was positive or when the level of post‐transplant viral load rose. Lamivudine given to 27 recipients markedly improved both 10‐year patient and graft survivals compared to Ag positive renal recipients who did not take lamivudine (85.3/59.2% vs. 49.9/22.7%, respectively, P < 0.0001). Overall, 13 viral breakthroughs among 24 lamivudine‐responsive patients were observed. The cumulative incidence of viral breakthrough at 60 months was 53.3%. Adefovir rescue in three viral breakthroughs patients induces virological response and restoration of liver function. In 10 patients who did not changed to adefovir, 6 patients are alive with elevated liver enzymes. In conclusion, in the era of lamivudine and adefovir, renal transplantation in HBsAg positive end‐stage renal disease patients should not be abandoned. J. Med. Virol. 79:1655–1663, 2007. © 2007 Wiley‐Liss, Inc.