Korean Journal of Nephrology 2001;20(1):80-86.

원저 : 신장 이식 후 만성 B 형 간염 치료로서 Lamivudine 의 효과와 안전성 (Efficacy and Safety of Lamivudine on Hepatitis B after Renal Transplantation)

구영훈(Young Hun Koo),정규영(Kyu Young Jung),최정호(Jung Ho Choi),김경원(Kyoung Won Kim),김은영(Eun Young Kim),박창근(Chang Keun Park),신태원(Tae Won Shin),정재성(Jae Sung Chung),공진민(Jin Min Kong)

Abstract

Renal graft recipients with hepatitis B virus(HBV) infection are at increased risk of fatal outcome, when 1they have serological evidence of active viral replication, such as HBV-DNA and/or HBeAg. Some pati- ents have been treated successfully with interferon. But the major drawback of this therapy is acute re- jection. Lamivudine is a potent inhibitor of hepatitis B virus replication. The aim of this study was to determine the efficacy and safety of lamivudine therapy in HBsAg positive renal recipients with active viral replication.. Of the 20 HBsAg positive renal transplants, 12 patients with positive HBV-DNA, determined by hybridization method, were given lamivudine. The doses of lamivudine ranged from 37.5 to 150mg/day according to the graft function of patients. Alanine aminotransferase(ALT), aspartate aminotransferase (AST), HBsAg, HBeAg, anti-HBe, HBV-DNA and creatinine were regularly monitored. Lamivudine was well tolerated without significant side effect. Viral replication was effectively suppre- ssed, as evidenced by negative conversion of serum HBV-DNA in 11 of 12 patients and reduction in HBV-DNA titer in 1 patient. In 3 patients who stopped lamivudine due to economic reason, HBV-DNA promptly increased to high titer, but decreased to undetectable level after retrial of medication. In 2 pa- tients with initial negative conversion of HBV-DNA and under continued medication, HBV-DNA reap- peared at 7 and 16 months respectively after initiation of lamivudine, with deterioration of hepatic func- tion in 1 patient. These patients with lamivudine resistant mutant continued medication with persistent low titer of HBV-DNA and without further aggravation of hepatic dysfunction. Lamivudine seems to inhibit HBV replication effectively in HBV-infected renal recipients and seems to be helpful in delaying the progression of liver disease. However, the optimal duration of treatment and long term efficacy and safety remain to be deter- mined.