Successful withdrawal of antiviral treatment in kidney transplant recipients with chronic hepatitis B viral infection

Cho, J.-H.; Lim, Jeong-Hoon; Park, G.-Y.; Kim, J.-S.; Kang, Yoon‐Jung; Kwon, Oh-Kyung; Choi, Ji-Young; Park, S.-H.; Kim, Y.-L.; Kim, H.-K.; Huh, Seung; Kim, C.-D.

doi:10.1111/tid.12202

Cited by 16 publications

(14 citation statements)

References 34 publications

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“…Reactivation beyond 12 months has been reported, so further monitoring should be considered, particularly for patients who received anti‐CD20 antibody therapy . Much less is known about the optimal duration of prophylaxis in patients receiving chronic immunosuppression, for example, transplantation and biological therapy …”

Section: Management Of Chronic Hbv In Special Populationsmentioning

confidence: 99%

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

et al. 2018

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Section: Management Of Chronic Hbv In Special Populationsmentioning

confidence: 99%

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

et al. 2018

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“…8 Hepatitis B surface antigenpositive patients who undergo renal transplant have higher morbidity and mortality than patients who continue on dialysis. 9 These results led to the proposal that HBV infection should be considered an absolute contraindication to renal transplant.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: Chronic hepatitis infection among kidney transplant recipients is not infrequent, with those with hepatitis C virus infection having worse survival. Here, we evaluated liver biopsy changes and its effects on prognosis in kidney transplant recipients. Materials and Methods: Patients with liver biopsies were selected from 1275 kidney transplant recipients who were treated at Başkent University from January 1990 to December 2012. Demographic and clinical findings were evaluated, including age, sex, liver biopsy findings, amyloid and hemosiderin accumulation, and patient survival. Results: Among 1275 renal transplant patients, only 149 patients had liver biopsies. Of 149 patients, 68 patients (45.3%) had liver biopsy only before and 81 patients had liver biopsy after transplant, with 20 of the 81 patients also having biopsy before transplant. The 81 patients who had a liver biopsy after renal transplant were included in the study. In our patient group, mean follow-up was 166 ± 29 months, femaleto-male ratio was 26/55, and mean age was 30.2 ± 9.87 years (range, 15-56 y). Only 2 of 81 liver biopsies (2.4%) were diagnosed as normal or nonspecific. Biopsy findings of the remaining 79 patients (97.6%) showed variable pathologies, including hepatocellular damage and minimal cholestatic changes in 29 patients (35.8%), chronic nonviral hepatitis in 9 (11.1%), and viral hepatitis in 41 (50.6%). The mean time between the first liver biopsy taken before transplant and second biopsy after transplant was 44.5 ± 38.0 months (range, 11-139 mo). Among 81 patients, 6 (7.4%) showed amyloid deposition and 13 (16.0%) showed hemosiderosis. Conclusions:Testing for viral infections is critical in transplant recipients. It is well known that these infections can affect the frequency of rejection episodes and also negatively affect survival in solidorgan transplant recipients. Livers should be evaluated by biopsy even if the variance in liver enzymes or serology is minimal.

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“…In 4 of them (66.7%) it was successfully discontinued and HBV DNA was still undetectable for a median 60.5 mo (range, 47-82 mo). In the other 2 patients HBV reactivated, but HBV DNA was again cleared after immediately resuming NUC therapy [65] . On the contrary, in LAM treatment discontinuation in 19 RT recipients after 2 years of treatment without adequate virological response, relapse rate was high (75%) [66] .…”

Section: Duration Of Therapy and Evaluation Of Responsementioning

confidence: 99%

“…A small recent study evaluated the long term results in HBV positive RT patients after NUC treatment discontinuation [65] . Fourteen patients treated with LAM (11 patients), ADV (1 patient), ETV (1 patient), and LdT (1 patient) were included in this study.…”

Section: Duration Of Therapy and Evaluation Of Responsementioning

confidence: 99%

“…Fourteen patients treated with LAM (11 patients), ADV (1 patient), ETV (1 patient), and LdT (1 patient) were included in this study. Patients were allowed to discontinue treatment if they have all of the following: (1) no clinical and histologic evidence of cirrhosis; (2) normal liver biochemistry; (3) negative for both HBV DNA and HBeAg; (4) no viral resistance; (5) antiviral therapy > 9 mo; (6) maintenance dosage of immunosuppressant for > 3 mo; and (7) no history of acute rejection during recent 6 mo [65] .…”

Section: Duration Of Therapy and Evaluation Of Responsementioning

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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Successful withdrawal of antiviral treatment in kidney transplant recipients with chronic hepatitis B viral infection

Abstract: Antiviral therapy can be discontinued successfully and safely in selected KTR with chronic HBV infection, after complete suppression of HBV and sufficient duration of antiviral therapy.

Cited by 16 publications

References 34 publications

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

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Antiviral treatment for chronic hepatitis B in renal transplant patients

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