Reactivation of hepatitis and lamivudine therapy in 11 HBsAg-positive renal allograft recipients: a single centre experience.
BACKGROUND
In hepatitis B virus (HBV) surface antigen (HBsAg) (+) renal allograft recipients, the mortality associated with liver disease reaches 37-78%. An antiviral agent, lamivudine, has recently been reported to be safe and effective for preventing hepatic damage in these patients, although either resurgence of HBV-DNA levels after discontinuation or emerging resistant HBV mutants caused by long-term administration are still unsettled.


METHODS
Between July 1976 and December 2003, 555 renal transplantations were performed in our centre. Of these, 11 patients who were HBsAg (+) at the time of transplantation (2.0%) were selected for this study. We investigated the incidence of hepatitis reactivation for three yr after transplantation and their clinical courses, including the efficacy of lamivudine therapy in seven of the 11 patients.


RESULTS
Six episodes of hepatitis reactivation developed in five of the 11 patients (45.5%) within three yr after transplantation. Five episodes of six occurred within four months after transplantation. The patient who underwent the most severe reactivation needed intensive care including lamivudine administration and plasma exchange. Lamivudine caused no severe adverse effects and HBV-DNA levels dropped to under measurable levels within four months after lamivudine administration in all patients. Resistant HBV mutant emerged in only one patient, who had the longest lamivudine administration of 49 months.


CONCLUSIONS
For HBsAg (+) renal allograft recipients, careful monitoring of HBV-DNA levels and timely administration of lamivudine could prevent hepatic damage caused by reactivation of hepatitis.
Murakami
Reiichi
R
Department of Surgery, Sendai Shakaihoken Hospital, Japan. h03gm410@stu.hirosaki-u.ac.jp
Amada
Noritoshi
N
Sato
Takaomi
T
Orii
Takashi
T
Kikuchi
Hiroyuki
H
Haga
Izumi
I
Ohashi
Yoichi
Y
Okazaki
Hajime
H
D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D024882:Drug Resistance, Viral; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D006509:Hepatitis B / Q000188:drug therapy* / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000235:genetics*; D006515:Hepatitis B virus / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D016030:Kidney Transplantation; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000821:virology; D012008:Recurrence; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine