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

Abstract

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.

Analysis of the Prevalence and Severity of Dysregulated Bone Mineral Homeostasis in Nondialyzed Chronic Kidney Disease Patients

“…Levels of total calcium concentration in CKD patients have been found to be low in studies conducted in varied geographical areas. 19 20 21 22 23 Furthermore, it was observed that serum PTH has linear negative correlation with serum total calcium ( R 2 : 0.37; p < 0.0001; Table 5 ) and linear positive correlation with serum phosphorous ( R 2 : 0.33; p < 0.0001; Table 5 ). In the study, it was also found that the serum PTH (331.68 ± 204.99 pg/mL) was significantly higher in patient group as compared with controls ( Table 2 ; p < 0.0001) and there was a significant progressive increase in levels of PTH with an advancing stage of CKD ( Table 4 ; ANOVA, p < 0.0001), which substantiates the relationship between severity of hyperparathyroidism and the degree of renal impairment.…”

“…Similar biochemical abnormalities were reported by few studies. For example, in 2016, Vikrant and Parashar 23 reported hypocalcemia in 23.8%, hyperphosphatemia in 55.4%, and secondary hyperparathyroidism in 82.7% patients; and Agarwal 21 illustrated hypocalcemia, hyperphosphatemia, and hyperparathyroidism in 29.9, 45, and 57.8% of CKD stage 4 patients, respectively. Progressive loss of kidney function in CKD leads to altered mineral homeostasis, that is reflected by an increasing prevalence of mineral disturbance with the advancing stages of CKD ( Table 3 ).…”

“…Our findings support the work of other researchers. 18 19 20 21 22 Among the inducted patient cohort, most commonly stated symptoms (related to CKD-MBD) were bone pains and myalgias, observed in 41.93% ( n : 52) of patients and most common comorbid conditions were diabetes mellitus ( n = 78 [62.9%]) and hypertension [ n = 63 [50.8%]).…”

Fabricating a Low-cost and Low-immune Xenogeneic Aortic Valve Bio Prosthesis

“…It is a critical problem for the patients to get an immunologically HLA-matched donor for organs like the heart and valves for transplant in emergencies [8]. The donated and HLAmatched transplanted aortic valves are not always safe, as this may already have many hidden glitches, including virological infections (HIV, HCV, HBV) [9]. In the future, there will be a high demand for allogeneic or immunologically HLA-matched donor organs.…”

Development of an experimental model of a decellularized kidney scaffold by perfusion mode and analyzing the three-dimensional extracellular matrix architecture by edge detection method

“…[ 4 ] The donated and matched (HLA) transplanted kidneys have risk of virus infections transmission (HIV, HCV, and HBC). [ 5 ] In absence of proper registry, it is assumed that nearly 3 lakh renal patients need dialysis or renal transplant. The dialysis and renal transplant are very expensive and the medical cost is difficult to be bear by the patient and their families.…”