title: Long-term impact of prophylactic antiviral treatment in Hepatitis B surface antigen positive renal allograft recipients.
abstract: BACKGROUND
  Antiviral prophylaxis has been shown to prevent hepatic dysfunction in Hepatitis B virus (HBV)-positive kidney transplantation recipients (KTRs). However the long-term effects of antiviral prophylaxis on the patient death, graft loss, or hepatic decompensation have not been determined.
  
  
  METHODS
  We therefore retrospectively analyzed outcomes in 94 HBV-positive patients, who underwent KT between February 1997 and November 2009 and were followed-up for a mean 75.7 months. Of the 94 KTRs, 56 received antiviral prophylaxis (Group 1), 51 with lamivudine and 5 with entecavir, and 38 did not (Group 2).
  
  
  RESULTS
  Of the latter group, 20 experienced HBV reactivation and 18 did not (mean 85 months); of those with reactivation, 16 received lamivudine, 2 received entecavir and 2 received no antiviral treatment. Cox-regression analysis showed that antiviral prophylaxis had no benefit on patient death (OR 1.29, 95% CI 0.37 - 4.49, p = 0.693), graft failure (OR 1.25, 0.45 - 3.46, p = 0.666) or hepatic decompensation (OR 2.01, 0.35 - 11.57, p = 0.434). Lamivudine resistance occurred in 21 lamivudine-treated Group 1 and 4 lamivudine-treated Group 2 patients (p = 0.243), with mean times of resistance after KT of 82 and 132 months, respectively (p = 0.001).
  
  
  CONCLUSIONS
  These findings indicate that lamivudine-based antiviral prophylaxis for HBV-positive renal recipients has no long-term clinical benefits.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. skpark@amc.seoul.kr
authors.forename: Kyung Sun
authors.initials: KS
authors.lastname: Park
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Yang
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Park
authors.forename: Su-Kil
authors.initials: SK
authors.lastname: Park
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens