title: Clinical outcome of renal transplantation in patients with positive pre-transplant hepatitis B surface antigen.
abstract: The clinical outcomes of 2,054 renal recipients were examined retrospectively based on pre-transplant hepatitis B surface antigen (HBsAg) status to investigate the efficacy of lamivudine treatment in HBsAg positive recipients. Pre-transplant HBsAg positivity was documented in 66 recipients. The 10-year patient and graft survival rates in Ag positive group were significantly lower than those of Ag negative group (64.4/36.6% vs. 88.2/70.5%, respectively, P < 0.0001). Since 1997, lamivudine was used when hepatitis B virus polymerase chain reaction (HBV PCR) was positive or when the level of post-transplant viral load rose. Lamivudine given to 27 recipients markedly improved both 10-year patient and graft survivals compared to Ag positive renal recipients who did not take lamivudine (85.3/59.2% vs. 49.9/22.7%, respectively, P < 0.0001). Overall, 13 viral breakthroughs among 24 lamivudine-responsive patients were observed. The cumulative incidence of viral breakthrough at 60 months was 53.3%. Adefovir rescue in three viral breakthroughs patients induces virological response and restoration of liver function. In 10 patients who did not changed to adefovir, 6 patients are alive with elevated liver enzymes. In conclusion, in the era of lamivudine and adefovir, renal transplantation in HBsAg positive end-stage renal disease patients should not be abandoned.
authors.affiliation: Department of Surgery, Yonsei University Medical Center, Seoul, South Korea.
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Ahn
authors.forename: Myoung Soo
authors.initials: MS
authors.lastname: Kim
authors.forename: Yu Seun
authors.initials: YS
authors.lastname: Kim
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Kyu Ha
authors.initials: KH
authors.lastname: Huh
authors.forename: Man Ki
authors.initials: MK
authors.lastname: Ju
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006085:Graft Survival; D006509:Hepatitis B / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D019259:Lamivudine / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine