Discontinuation of lamivudine treatment for hepatitis flare after kidney or heart transplantation in hepatitis B surface antigen-positive patients: A retrospective case series.
BACKGROUND
Limited data are available on the clinical course of hepatitis B virus (HBV) infection after discontinuation of lamivudine prescribed for kidney or heart posttransplantation hepatitis flare


OBJECTIVE
The purpose of this study was to investigate the reasons for discontinuation, subsequent reappearance of HBV DNA, and mortality in heart and kidney transplant recipients who discontinued lamivudine treatment.


METHODS
This retrospective case series followed up male and female hepatitis B surface antigen (HBsAg)-positive Taiwanese transplant recipients from the National Taiwan University Hospital, Taipei, Taiwan, between July 1989 and January 1999. Biochemical, virologic, and serologic parameters and liver-related mortality of patients who discontinued lamivudine 100 mg QD prescribed for posttransplantation hepatitis flare were compared with those in a group of patients who continued use of lamivudine administered for the same indication over the same period of time. Serum HBV DNA levels were checked in all patients before and after discontinuation of lamivudine, and after resumption of lamivudine treatment and in patients with breakthrough hepatitis flare.


RESULTS
A total of 39 HBsAg-positive transplant recipients (mean [SD] age, 45 [10.0] years) were identified during regular follow-up visits. Nine patients discontinued lamivudine use; 11 patients who continued it were selected as a control group. No significant between-group differences were observed in mean (SD) age (46 [14.0] vs 45 [6.9] years), sex (men/women,vs 1), type of transplant received (heart/kidney,vs ), or pretransplantation liver function test results. The reasons for discontinuation were informed patient decision (4 patients); YMDD mutation (2); self-discontinuation without physician consultation (2); and pregnancy (1). Of those who discontinued lamivudine, serum HBV DNA was undetectable at a mean of 30 (range, 9-47) months' follow-up in 6 (66.7%) of 9 patients. Lamivudine treatment was resumed in 3 patients on reappearance of HBV DNA, and a subsequent rapid decline in the serum HBV DNA was observed. The liver-related mortality rate was not significantly higher in patients who discontinued treatment compared with continuously treated patients (both, 0%). The between-group difference in overall mortality rates was not significant (22.2% and 18.2%, respectively).


CONCLUSIONS
This case series illustrated a variety of clinical situations in which discontinuation of lamivudine treatment prescribed for posttransplantation hepatitis flare may occur. However, liver-related mortality was not increased in these patients compared with those who continued lamivudine treatment.
Huang
Yi-Wen
YW
Liver Unit, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.
Liu
Chun-Jen
CJ
Lai
Ming-Yang
MY
Lee
Po-Huang
PH
Tsai
Meng-Kung
MK
Wang
Shoei-Shen
SS
Lai
Ming-Kuen
MK
Kao
Jia-Horng
JH
D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006509:Hepatitis B / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine