Twelve months of lamivudine treatment for chronic hepatitis B virus infection in renal transplant recipients.
BACKGROUND
Chronic hepatitis B virus (HBV) infection increases morbidity and mortality in renal transplant recipients (RTR). Lamivudine has shown promising results in patients with chronic hepatitis B, but experience with its use in RTR is limited.


METHODS
In a prospective, open labeled, uncontrolled trial, 19 HBsAg(+) RTR were treated with lamivudine for 12 months. HBV-serologic analysis, HBV-DNA quantitation, and HBV genome sequence analysis were performed every 3 months.


RESULTS
At baseline 16 patients were HBV DNA(+), 12 patients were HBeAg(+)/Ab (-). After 3 months HBV DNA was negative in 80% of patients. In the 3 patients with elevated liver enzymes, normal values were achieved within 12 weeks. At 12 months 4 of 8 HBeAg(+)/Ab(-) patients on treatment showed HBeAb, two of them with loss of HBeAg. Three patients developed mutations of the HBV polymerase gene associated with lamivudine resistance.


CONCLUSIONS
Lamivudine is safe and effective in HB-sAg(+) RTR, the rate of HBe-seroconversion and of lamivudine-resistance is comparable to that of nonimmunosuppressed patients.
Kletzmayr
J
J
Department of Medicine, University of Vienna, Vienna, Austria. josef.kletzmayr@nephro.imed3.akh-wien.ac.at
Watschinger
B
B
Müller
C
C
Demetriou
D
D
Puchhammer-Stöckl
E
E
Ferenci
P
P
Kovarik
J
J
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000188:drug therapy*; D006510:Hepatitis B Antibodies / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D016030:Kidney Transplantation; D019259:Lamivudine / Q000627:therapeutic use*; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D013997:Time Factors
D019380:Anti-HIV Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine