title: Evolution of hepatitis B management in kidney transplantation.
abstract: Chronic hepatitis B virus (HBV) infection adversely influences the clinical outcomes of renal transplant recipients owing to increased hepatic complications. Management of HBV infection in kidney transplant recipients presents a challenge to clinicians, especially in endemic regions. Interferon precipitates renal allograft dysfunction. Treatment with lamivudine, the first oral nucleoside analogue available, resulted in effective viral suppression, reduced liver-related complications, and improved patient survival so that medium-term data showed comparable patient survival rates between hepatitis B surface antigen-positive and HBsAg-negative kidney transplant recipients in the era of effective antiviral therapies. Entecavir has replaced lamivudine as first-line therapy for treatment-naïve subjects in view of the propensity for drug resistance with the latter. Management of HBV infection in kidney transplant patients needs to take into consideration the nephrotoxicity of nucleoside/tide analogues such as adefovir and tenofovir. Prevention of HBV-related complications in kidney transplant recipients starts much earlier prior to transplantation, with vaccination of patients with chronic kidney disease and donor-recipient matching with regard to HBV status. In addition to anti-viral treatment, patients with chronic HBV infection must have regular surveillance for liver cancer and assessment for the development of cirrhosis.
authors.affiliation: Desmond Y H Yap, Tak Mao Chan, Division of Nephrology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China.
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.affiliation: Desmond Y H Yap, Tak Mao Chan, Division of Nephrology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China.
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D024882:Drug Resistance, Viral; D006085:Graft Survival / Q000187:drug effects; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000635:transmission; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006514:Hepatitis B Surface Antigens
keywords: Hepatitis B; Kidney transplantation