Lamivudine therapy for hepatitis B in renal transplantation

Santos, F; Haiashi, A.R.M.; Araújo, Maria; Abensur, Henry; Romão, João Egídio; Noronha, Irene L.

doi:10.1590/s0100-879x2002000200008

Cited by 7 publications

(4 citation statements)

References 18 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The duration of lamivudine therapy was 6–12 months in the majority (11 of 14) of the studies. Later clinical trials (369–375) have shown similar results with lamivudine monotherapy given for 24–69 months. HBeAg and HBV‐DNA clearance occurred in 0–25% and 43–78%, respectively.…”

Section: Rationalementioning

confidence: 83%

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,124

247

View full text Add to dashboard Cite

Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2009.02834.x S2 American Journal of Transplantation 2009; 9 (Suppl 3): S2-S2Since the first successful kidney transplantation in 1954 It is our hope that this document will serve several useful purposes. Our primary goal is to improve patient care. We hope to accomplish this in the short term by helping clinicians know and better understand the evidence (or lack of evidence) that determines current practice. By making this guideline broadly applicable, our purpose is to also encourage and enable the establishment and development of transplant programs worldwide. Finally, by providing comprehensive evidence-based recommendations, this guideline will also help define areas where evidence is lacking and research is needed. Helping to define a research agenda is an often neglected, but very important function of clinical practice guideline development.We used the GRADE system to rate the strength of evidence and the strength of recommendations. In all, there were only 4 (2%) recommendations in this guideline for which the overall quality of evidence was graded 'A,' whereas 27 (13.6%) were graded 'B,' 77 (38.9%) were graded 'C,' and 90 (45.5%) ' and 148 (74.7%) graded '2.' There were 3 (1.5%) recommendations graded '1A,' 16 (8.1%) were '1B,' 18 (9.1%) were '1C, ' and 13 (6.6%) were '1D.' There was 1 (0.5%) graded '2A,' 11 (5.6%) were '2B,' 59 (29.8%) were '2C, ' and 77 (38.9%) BackgroundExcept perhaps for transplantation between identical twins, all kidney transplant recipients (KTRs) need immunosuppressive medications to prevent rejection. Induction therapy is treatment with a biologic agent, either a lymphocyte-depleting agent or an interleukin 2 receptor antagonist (IL2-RA), begun before, at the time of, or immediately after transplantation. The purpose of induction therapy is to deplete or modulate T-cell responses at the time of antigen presentation. Induction therapy is intended to improve the efficacy of immunosuppression by reducing acute rejection, or by allowing a reduction of other components of the regimen, such as calcineurin inhibitors (CNIs) or corticosteroids. Available lymphocytedepleting agents include antithymocyte globulin (ATG), antilymphocyte globulin (ALG) and monomurab-CD3. Basiliximab and daclizumab, the two IL2-RAs that are currently available in many parts of the world, bind the CD25 antigen (interleukin-2 [IL2] receptor a-chain) at the surface of activated T-lymphocytes and thereby competitively inhibit IL2-mediated lymphocyte activation, a crucial phase in cellular immune response of allograft rejection. Rationale• There is high-quality evidence that the benefits of IL2-RA vs. no IL2-RA (or placebo) outweigh harm in a broad range of KTRs with variable immunological risk and concomitant immunosuppressive medication regimens.• There is moderate-quality evidence that a lymphocytedepleting agent vs. no lymphocyte-depleting a...

show abstract

Section: Rationalementioning

confidence: 83%

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,124

247

View full text Add to dashboard Cite

show abstract

“…HBeAg positivity was variable ranging from 17–100% patients while in our study it was 77%. In five studies[14172527–28] liver enzyme status at the time of starting lamivudine was not available, while in the remaining studies, ALT was elevated in most of the patients. Liver biopsy findings were not available in eight studies.…”

Section: Discussionmentioning

confidence: 99%

“…Enzyme normalization status was not available in six studies,[141718212225] while in rest of studies it was seen in 53–100% patients. Hepatocytes damage in the course of chronic hepatitis B is mainly immune mediated, in addition to a less significant role of direct HBV hepatotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of lamivudine in hepatitis B infected renal transplant recipients: A single center study

Agarwal¹,

Sc²

2009

Indian J Nephrol

View full text Add to dashboard Cite

Hepatitis B virus (HBV) infection in patients on hemodialysis and renal transplantation (RT) usually has an unfavorable course. Lamivudine is a synthetic nucleoside analog with a potent action on HBV replication. There is limited data on lamivudine in renal transplant patients with HBV infection and no published report from India. Present study reports on lamivudine therapy in these patients. Patients with HBV infection taken for RT were included. Hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), HBV-DNA, and liver biopsy before RT were done in all patients. Lamivudine was given in the dose of 50 mg daily during the dialysis and 100 mg daily following successful transplant. Response was evaluated at one year. Of the 739 adult RTs during study period, 35 (4.7%) had HBV infection. Mean age of patients was 30.7 ± 9.8 (16–55 years) and 88.5% were males. Four (11.4%) patients had HCV coinfection. HCV was not treated in any patient. All patients were HBsAg and HBV-DNA positive, while 27 (77%) were HBeAg positive. Mean ALT was 77.8 ± 90 IU/dl; 11 (31.4%) patients had normal ALT. Mean liver biopsy grade was 5.2 ± 1.5 (3–9) and stage was 0.7 ± 0.6 (0–2). At one year following transplantation, ALT was normal in 27 (77%) cases, HBV-DNA undetectable in 16 (45.7%), HBeAg and HBsAg seroconversion in 8 (22.8%), and 3 (8.6%) cases, respectively. All patients tolerated the drug without any significant side effects. Treatment with lamivudine in dialysis and renal transplant patients is well tolerated and safe with efficacy comparable to patients with normal renal function.

show abstract

“…Although few studies have post-RT liver biopsy data, a recent report from Zubkin et al demonstrated a decrease in liver inflammatory activity and fibrosis in 3 of 4 HBV-infected recipients post-RT treated with lamivudine [53]. In other reports, lamivudine monotherapy was given for 24 to 69 months (n=116 patients) [54][55][56][57][58]. Many of these RT recipients (53/118) were HBeAg positive.…”

Section: Therapy Of Hepatitis B After Rt: Lamivudinementioning

confidence: 99%

Management of Chronic Hepatitis B in Special Populations: Immunosuppressed Patients and Chronic Kidney Disease

2011

View full text Add to dashboard Cite

Hepatitis B virus (HBV) infection remains an important cause of liver disease in the population with chronic kidney disease, including patients on long-term dialysis and renal transplant (RT) recipients. Diminished survival due to hepatitis B has been observed after RT. A thorough evaluation, including liver biopsy as well as assessment of serum markers of HBV replication (ie, hepatitis B e antigen and/or HBV DNA) is required before transplantation. Tolerance to interferon is poor both in dialysis patients and after renal transplant. Oral antiviral therapy now permits safe and potent antiviral treatment of HBV-related liver disease in chronic kidney disease patients with prevention of progressive liver disease. Preliminary evidence shows an improved survival of HBsAg positive renal allograft recipients on antiviral therapy. However, numerous issues concerning the treatment of hepatitis B in the population with chronic kidney disease remain unclear and further clinical trials are needed.

show abstract

Lamivudine therapy for hepatitis B in renal transplantation

Cited by 7 publications

References 18 publications

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Efficacy and tolerability of lamivudine in hepatitis B infected renal transplant recipients: A single center study

Management of Chronic Hepatitis B in Special Populations: Immunosuppressed Patients and Chronic Kidney Disease

Contact Info

Product

Resources

About