Nephrol Dial Transplant (2001) 16: 2222-2228
© 2001 European Renal Association-European Dialysis and Transplant Association
Outcome of renal transplantation in hepatitis B surface antigen-positive patients after introduction of lamivudine
Department of Internal Medicine, Pathology, and General Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea Republic
Background. In end-stage renal disease patients with hepatitis B surface antigen (HBsAg), the risk of hepatic dysfunction after immunosuppression represents a large barrier in renal transplantation. Lamivudine is a potent inhibitor of hepatitis B virus (HBV) replication. We retrospectively investigated the outcome of HBsAg-positive renal transplantation recipients after lamivudine had become available.
Methods. From July 1994 to August 2000, seventeen HBsAg-positive patients (M:F=15:2) received renal allografts (13:4=living:cadaveric donors). Liver function tests at the time of transplantation were normal in all patients. Pre-transplant liver biopsies performed in 15 patients demonstrated minimal inflammatory histology, except in three patients showing pathological and clinical signs of active hepatitis. Lamivudine was started pre-operatively in these three subjects. Another seven patients were treated with lamivudine for post-operative hepatic dysfunction. The remaining seven patients did not develop hepatic dysfunction after transplantation.
Results. Lamivudine was initially effective in decreasing serum HBV DNA titres, and in normalizing hepatic enzymes. Lamivudine was well tolerated without significant side effects for 35.5±8.9 months after initiation of treatment. HBV DNA became negative in nine patients but remained positive in one patient. Among the nine patients with initial negative conversion of HBV DNA, two developed transient positive conversion of HBV DNA and two demonstrated persistent positive conversion. Among the patients with normal liver histology in the pre-transplant period, 41.6% (5/12) developed liver pathology progression after immunosuppression. All 17 patients had functioning grafts, except for one patient who developed relapsed IgA nephropathy.
Conclusions. Our data showed relatively favourable outcomes in hepatitis B-positive renal transplant recipients receiving lamivudine treatment, even though two patients developed lamivudine resistance.
Keywords: hepatitis B; lamivudine; liver biopsy; prognosis; renal transplantation
Presented in part at the first joint meeting of the American Society of Transplantation, Chicago, Illinois, USA, May 14, 2000.
Correspondence and offprint requests to: Su-Kil Park, MD, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Song-Pa, PO Box 145, Seoul 138-736, Korea Republic. Email: skpark{at}www.amc.seoul.kr