RESULTS ON PREEMPTIVE OR PROPHYLACTIC TREATMENT OF LAMIVUDINE IN HBsAg (+) RENAL ALLOGRAFT RECIPIENTS: COMPARISON WITH SALVAGE TREATMENT AFTER HEPATIC DYSFUNCTION WITH HBV RECURRENCE

Han, Duck Jong; Kim, Tae Hyong; Park, Su K.; Lee, Sang K.; Kim, Soon B.; Yang, Won Seok; Park, Jung S.; Jung, Jae Gu; Yu, Eun Sil; Kim, Song C.

doi:10.1097/00007890-200102150-00008

Cited by 69 publications

(35 citation statements)

References 24 publications

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“…10,11 Short-term studies have shown virologic and biochemical efficacy in small series of renal transplant recipients. [12][13][14][15][16] We and others have reported favorable results with lamivudine in the treatment of fibrosing cholestatic hepatitis B, which hitherto has been associated with nearly uniform mortality. 17,18 However, many critical issues remain unresolved.…”

Section: See Editorial On Page 1041 H Epatitis B Virus (Hbv) Infectiomentioning

confidence: 99%

Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients

et al. 2002

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Hepatitis B surface antigen (HBsAg)-positive kidney transplant recipients have increased liver-related mortality. The impact of lamivudine treatment on patient survival, the optimal time to start treatment, and the feasibility of discontinuing treatment have not been determined. This study examined these issues with a novel management protocol. Serum hepatitis B virus (HBV) DNA levels were measured serially in HBsAg-positive kidney transplant recipients, and lamivudine was administered preemptively to patients with increasing HBV DNA levels with or without elevation of aminotransferase levels. Outcomes of patients who underwent transplantation before or after institution of this preemptive management strategy (in January 1996) were compared. H epatitis B virus (HBV) infection is an importantcause of morbidity and mortality after kidney transplantation. [1][2][3][4][5] The number of chronic HBV carriers exceeds 300 million worldwide, and up to 14% of renal allograft recipients in endemic areas are hepatitis B surface antigen (HBsAg) positive. 6,7 Progressive liver disease affects more than 80% of HBsAg-positive renal transplant recipients 8,9 and accounts for 37% to 57% of mortality. 3,4,9 Life-threatening exacerbation of liver disease can develop in previously healthy HBV carriers. An optimal monitoring and treatment regimen for HBsAg-positive renal allograft recipients has not been defined.Lamivudine is a nucleoside analogue with proven efficacy in suppressing HBV DNA levels and ameliorating aminotransferase and histologic abnormalities in nonimmunosuppressed patients with chronic hepatitis B. 10,11 Short-term studies have shown virologic and biochemical efficacy in small series of renal transplant recipients. [12][13][14][15][16] We and others have reported favorable results with lamivudine in the treatment of fibrosing cholestatic hepatitis B, which hitherto has been associated with nearly uniform mortality. 17,18 However, many critical issues remain unresolved. It is not known whether patient survival can be Abbreviations: HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; ALT, alanine aminotransferase; HBeAg, hepatitis B e antigen.

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Section: See Editorial On Page 1041 H Epatitis B Virus (Hbv) Infectiomentioning

confidence: 99%

Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients

et al. 2002

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“…None of the HBsAg positive patients receiving prophylactic or pre-emptive therapy developed reactivation, while 50% of the patients not been treated suffered reactivation [51,52] . These results were confirmed by others, but there is some controversy about the clinical impact of prophylactic/preemptive therapy vs salvage therapy [51][52][53][54][55] . One study showed that there was no differences in survival between HBsAg positive RT patients treated preemptively with LAM and HBsAg negative controls.…”

Section: Ridruejo E Nuc Treatment In Rt Patientsmentioning

confidence: 94%

Section: Ridruejo E Nuc Treatment In Rt Patientsmentioning

confidence: 99%

“…In a small study, LAM given as either prophylactic or preemptive treatment was proven superior to salvage therapy when liver dysfunction is evident [51] . None of the HBsAg positive patients receiving prophylactic or pre-emptive therapy developed reactivation, while 50% of the patients not been treated suffered reactivation [51,52] . These results were confirmed by others, but there is some controversy about the clinical impact of prophylactic/preemptive therapy vs salvage therapy [51][52][53][54][55] .…”

Section: Ridruejo E Nuc Treatment In Rt Patientsmentioning

confidence: 99%

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Antiviral treatment for chronic hepatitis B in renal transplant patients

Ridruejo

2014

WJH

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Chronic hepatitis B infection is frequent in renal transplant patients. It negatively impacts long term outcomes reducing graft and patient survival. Current guidelines clearly define who needs treatment, when to start, what is the first line therapy, how to monitor treatment response, when to stop, and how patients must be controlled for its safety. There is some data showing a favorable safety and efficacy profile of nucleos(t)ide analogue (NUC) treatment in the renal transplant setting. Entecavir, a drug without major signs of nephrotoxicity, appears to be the first option for NUC naïve patients and tenofovir remains the preferred choice for patients with previous resistance to lamivudine or any other NUC. Renal transplant recipients under antiHBV therapy should be monitored for its efficacy against HBV but also for its safety with a close renal monitoring. Studies including a large number of patients with long term treatment and follow up are still needed to better demonstrate the safety and efficacy of newer NUCs in this population. Core tip: Nucleos(t)ide analogue treatment is safe and effective in renal transplant patients. It improves long term patients and graft survival.Ridruejo E. Antiviral treatment for chronic hepatitis B in renal transplant patients.

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“…However, renal transplant recipients with active HBV (HBsAg positive) should be started on antiviral therapy at the time of transplantation irrespective of HBV DNA levels (Han et al, 2001;Filik et al, 2006) or even during dialysis to prevent worsening of liver disease after transplantation. The primary goals of management are maximal suppression of viral replication, while minimizing development of resistance and prevention of hepatic fibrosis.…”

Section: Timing Of Initiationmentioning

confidence: 99%