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Review
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Korean J Med. 2006;71(1):164-164.
- Efficacy and safety of nucleos(t)ide analogues on renal transplant recipients with chronic hepatitis b virus(hbv) infection
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- Efficacy and safety of nucleos(t)ide analogues on renal transplant recipients with chronic hepatitis b virus(hbv) infection
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1Department of Internal Medicine, Hanyang University College of Medicine, Seoul; 2Department of Life Science, Postech Biotech Center, Pohang University of Science and Technology, Pohang, Korea
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- Abstract
- It has been suggested that HBV infection is associated with poorer patient and graft outcome of kidney transplant patients
mainly due to the progression of liver disease by the adverse influence of immunosuppressants. Recently introduced nucleos(t)ide
analogues such as lamivudine(LAM) and adefovir(ADE) can effectively inhibit HBV replication and may alter the clinical courses
of these patients. Data regarding long term outcome of HBsAg(+) renal transplant recipients treated with nucleos(t)ide analogues
are scarce. Since 1998, when LAM became available in our center, 25 HBsAg(+) patients have been followed up or received renal
allograft. One of these patients was co-infected with HCV. Liver biopsy was performed before transplantation in 21(84%) of 25
patients. Knodell score was 3.5¡¾2.7. Seventeen of 25 patients received LAM 50-150mg/day. In 13 patients, LAM was started
when HBVDNA level, determined by hybrid capture assay, revealed positive. In the other 4 patients with negative HBVDNA,
LAM was started at perioperative period preemptively. Eight of LAM-treated patients were HBeAg(+). Mean follow up after
initiation of nucleos(t)ide analogues is 62¡¾33(16-102) months. All patients with initially positive HBVDNA(n=13) responded to
LAM with decrement of HBVDNA titer. Mean duration of LAM treatment in these patients was 62(16-93) months. Ten(59%)
of 17 patients developed HBVDNA break-through at 27¡¾19(8-67) months after LAM initiation. Nine of 10 LAM-resistant
patients were changed from LAM to ADE. Mean duration of ADE treatment was 16¡¾7(6-24)months. One patient developed
ADE-breakthrough at 16 M of treatment. One HBeAg seroconversion was observed, but no HBsAg seroconversion. No cases
of Hepatic failure or progressive biochemical deterioration developed during nucleos(t)ide analogue administration. We conclude
1) nucleos(t)ide analogues effectively and safely inhibit HBV replication in renal transplant recipients, 2)this effective control of
viral replication may improve the long term outcome of renal transplant patients with chronic HBV infection.
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