title: Telbivudine prophylaxis for hepatitis B virus recurrence after liver transplantation improves renal function.
abstract: BACKGROUND
  Renal impairment after liver transplantation represents an important issue in the management of transplantation patients, particularly when those subjects may need prophylaxis for fungal or viral infection. Herein we report our experience with 12 transplantation patients receiving telbivudine 600 mg/d while on the waiting list, followed by treatment for 18 months after liver transplantation, showing an improvement on their renal function during the follow-up period.
  
  
  METHODS
  Our series consisted of men with hepatitis B virus (HBV)-related end-stage liver disease. The viral load decreased rapidly while on the waiting list once the patient was started on antiviral treatment. Those subjects were compared with 12 patients on lamivudine prophylaxis. All patients were evaluated for liver and renal function, immunosuppression trough levels, and creatine phosphokinase (CPK) before liver transplantation (T0) and at 3, 6, 12, and 18 months (T3, T6, T12, T18).
  
  
  RESULTS
  All patients received a calcineurin inhibitor immunosuppression-based regimen. Creatinine clearance (Modification of Diet in Renal Disease) was 67 mL/min at T0, with a statistically significant improvement after month 6 compared with those on lamivudine and with the value at the beginning of the prophylaxis (Mann-Whitney U test P<.05). Neither CPK nor transaminase serum levels increased throughout the study period. Once HBV DNA was cleared while on the waiting list, it remained negative throughout the follow-up period.
  
  
  CONCLUSIONS
  Telbivudine prophylaxis for HBV is safe and effective, without any significant deleterious effect on the liver; on the contrary, it seems to improve renal function after liver transplantation through 18 months. Further studies and larger series are warranted to confirm these findings.
authors.affiliation: Laparoscopic, Hepatic and Liver Transplant Unit, AORN A. Cardarelli, Naples, Italy; VII Department of Infectious Disease and Immunology, AORN Monaldi-Cotugno-CTO, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Perrella
authors.affiliation: Hepatology Unit, AORN A. Cardarelli, Naples, Italy.
authors.forename: A G
authors.initials: AG
authors.lastname: Lanza
authors.affiliation: Laparoscopic, Hepatic and Liver Transplant Unit, AORN A. Cardarelli, Naples, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pisaniello
authors.affiliation: Hepatology Unit, AORN A. Cardarelli, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: DiCostanzo
authors.affiliation: Hepatobiliary Surgery and Liver Transplant Center, AORN A. Cardarelli, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Calise
authors.affiliation: Laparoscopic, Hepatic and Liver Transplant Unit, AORN A. Cardarelli, Naples, Italy. Electronic address: oreste.cuomo@aocardarelli.it.
authors.forename: O
authors.initials: O
authors.lastname: Cuomo
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003404:Creatinine / Q000032:analysis*; D005260:Female; D019694:Hepatitis B, Chronic / Q000517:prevention & control*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D000077712:Telbivudine; D013936:Thymidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D000077712:Telbivudine; D019259:Lamivudine; D003404:Creatinine; D013936:Thymidine