title: Successful withdrawal of antiviral treatment in kidney transplant recipients with chronic hepatitis B viral infection.
abstract: BACKGROUND
  The optimal duration of antiviral therapy for kidney transplant recipients (KTR) with chronic hepatitis B virus (HBV) infection remains unclear. We reported the long-term outcomes after withdrawal of antiviral agent in KTR with chronic HBV infection.
  
  
  METHODS
  We retrospectively investigated the hepatitis B surface antigen (HBsAg)-positive KTR with antiviral agents between January 2002 and January 2012. Antiviral treatments were withdrawn in patients who met all of the following 7 criteria: (i) no clinical and histologic evidence of cirrhosis, (ii) normal liver biochemistry, (iii) negative for both HBV DNA and hepatitis B envelope antigen (HBeAg), (iv) no resistance to antiviral agent, (v) antiviral therapy > 9 months, (vi) maintenance dosage of immunosuppressant for > 3 months, and (vii) no history of acute rejection during recent 6 months. All patients were followed regularly at approximately 3-6 months for liver enzyme, viral markers, and HBV DNA level after antiviral withdrawal.
  
  
  RESULTS
  Among a total of 445 KTR, 14 HBsAg-positive patients were included in this study. Antiviral agents were used, with lamivudine in 11 patients, and with adefovir, entecavir, and telbivudine in 3 patients, respectively. Discontinuation of antiviral agent was attempted in 6 (42.9%) of 14 patients who satisfied the criteria. The median duration of antiviral therapy before withdrawal was 14.3 months (range, 9-24 months). Four (66.7%) of 6 patients were successfully withdrawn and remained negative for HBV DNA for a median 60.5 months (range, 47-82 months). The baseline HBV DNA level was not related to maintenance of remission after withdrawal. Two reactivated patients resumed antiviral treatment immediately, with subsequent normalization of HBV DNA. During the follow-up, 1 patient developed hepatocellular carcinoma; however, no patient death or graft failure was reported for all HBsAg-positive KTR.
  
  
  CONCLUSIONS
  Antiviral therapy can be discontinued successfully and safely in selected KTR with chronic HBV infection, after complete suppression of HBV and sufficient duration of antiviral therapy.
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea; Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Cho
authors.forename: J-H
authors.initials: JH
authors.lastname: Lim
authors.forename: G-Y
authors.initials: GY
authors.lastname: Park
authors.forename: J-S
authors.initials: JS
authors.lastname: Kim
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Kang
authors.forename: O
authors.initials: O
authors.lastname: Kwon
authors.forename: J-Y
authors.initials: JY
authors.lastname: Choi
authors.forename: S-H
authors.initials: SH
authors.lastname: Park
authors.forename: Y-L
authors.initials: YL
authors.lastname: Kim
authors.forename: H-K
authors.initials: HK
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Huh
authors.forename: C-D
authors.initials: CD
authors.lastname: Kim
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000276:immunology / Q000502:physiology*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D012189:Retrospective Studies; D000077712:Telbivudine; D013936:Thymidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014775:Virus Activation; D028761:Withholding Treatment
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D007166:Immunosuppressive Agents; D063065:Organophosphonates; D000077712:Telbivudine; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000410:Alanine Transaminase; D000225:Adenine; D013936:Thymidine
keywords: antiviral treatment; hepatitis B virus; kidney transplantation; withdrawal