Hepatitis B surface antigen (HBsAg)-positive kidney transplant recipients have increased liver-related mortality.
In this study, a research team from Hong Kong, China, examined the impact of lamivudine treatment on patient survival using a novel management protocol.
In addition, they examined the optimal time to start treatment, and the feasibility of discontinuing treatment.
They team measured serum hepatitis B virus (HBV) DNA levels serially in HBsAg-positive kidney transplant recipients.
Lamivudine was administered preemptively to patients with increasing HBV DNA levels, with or without elevation of aminotransferase levels.
The research team compared outcomes of patients who underwent transplantation before or after this preemptive management strategy.
During the study, 11 de novo patients and 15 existing patients received preemptive lamivudine therapy for 33 months.
The treatment criteria were met by de novo patients at 8 months after transplantation.
|Suppression of HBV DNA and normalization of aminotransferase levels occurred in all treated patients.|
The team identified suppression of HBV DNA and normalization of aminotransferase levels in all treated patients.
In addition, 21% had hepatitis B e antigen (HBeAg) seroconversion.
The team found that the survival of preemptively managed de novo transplant patients was similar to that of HBsAg-negative controls,
However, HBsAg-positive patients who underwent transplantation before institution of the preemptive management strategy, had inferior survival.
Lamivudine resistance developed in 40% of the patients.
The team attempted discontinuation of lamivudine in 12 low-risk patients after stabilization and was successful in 5.
Dr Tak Mao Chan's team concluded, "Preemptive lamivudine therapy based on serial HBV DNA levels and clinical monitoring improved the survival of HBsAg-positive renal allograft recipients".
"Treatment can be discontinued safely in selected patients after stabilization to minimize the selection of drug-resistant HBV mutants".
In a related editorial in the same publication, Dr Robert Perrillo, from Louisiana, USA, discusses the impact of HBV on progressive liver disease and survival after renal transplantation.
Dr Perrillo concludes, "Several questions remain unanswered with regard to the management of HBsAg-positive patients who undergo kidney transplantation".
"It is a reasonably safe bet, however, that the availability of a number of safe and effective medical treatments for chronic HBV infection will greatly diminish the potential impact that these questions have on management decisions in the future".