title: Long-term effects of prophylactic and therapeutic lamivudine treatments in hepatitis B surface antigen-positive renal allograft recipients.
abstract: BACKGROUND
  Among hepatitis B surface antigen (HBsAg)-positive renal allograft recipients, post-transplant immunosuppression is associated with the occurrence of hepatocellular carcinoma (HCC) and liver-related complications. Lamivudine has proven beneficial in short-term post-transplant follow-up.
  
  
  METHODS
  Between 2000 and 2009, 26 adult HBsAg-positive renal allograft recipients received lamivudine prophylaxis (Group 1) and another 28 patients received therapeutic lamivudine (Group 2) due to post-transplant hepatitis B reactivation. The historical control group included 43 HBsAg-positive renal allograft recipients who did not receive lamivudine therapy (Group 3).
  
  
  RESULTS
  No subjects in Group 1 presented HCC or liver-related complications and the 10-year HCC incidence of Group 2 and Group 3 was 4.2 and 34 %, respectively. Furthermore, the HCC-free survival rates as well as the 10-year patient and graft survival rates of Group 1 and Group 2 were significantly higher than those of Group 3. However, the rates of liver-related complications and graft rejection of Group 2 and Group 3 were both higher than those of Group 1. Additionally, the HBV mutation-free rate of lamivudine was significantly higher in Group 1 than in Group 2.
  
  
  CONCLUSIONS
  Lamivudine antiviral treatment, either on a prophylactic or therapeutic basis, provided long-term benefits for HBsAg-positive renal allograft recipients, in terms of reducing the occurrence of HCC and prolonging patient and graft survival. Furthermore, compared with therapeutic lamivudine, lamivudine prophylaxis appears to significantly reduce the incidence of liver-related complications, graft rejection, and lamivudine resistance.
authors.affiliation: Division of General Surgery, National Taiwan University and National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Yang
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Lee
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
authors.forename: Meng-Kun
authors.initials: MK
authors.lastname: Tsai
mesh_terms: D000328:Adult; D064591:Allografts; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000517:prevention & control; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D019259:Lamivudine / Q000008:administration & dosage* / Q000009:adverse effects; D008113:Liver Neoplasms / Q000401:mortality / Q000517:prevention & control / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D019259:Lamivudine