| Effect of Lamivudine Treatment in Renal Transplant Recipient with HBsAg-Positivity |
| Sang Woo Han, M.D., Jin Young Kim, M.D., Su Hyun Kim, M.D., Bum Soon Choi, M.D., Cheol Whee Park, M.D., Chul Woo Yang, M.D., Yong Soo Kim, M.D., Suk Young Kim, M.D., Yoon Sik Chang, M.D. and Byung Kee Bang, M.D. |
| Department of Internal Medicine, College of Medicine The Catholic University of Korea, Seoul, Korea |
| B형 간염 신 이식 환자에서의 라미뷰딘 치료 효과 |
| 한상우,김진영,김수현,최범순,박철휘,양철우,김용수,김석영,장윤식,방병기 |
| 가톨릭대학교 의과대학 내과학교실 |
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| Abstract |
Background
: Immunosuppressive therapy after renal transplantation stimulates the replication of hepatitis B virus (HBV) and may lead to increased liver-related mortality. We investigated the effectiveness of lamivudine for the treatment of HBV reacti-vation in renal transplant recipients.
Methods
: We reviewed the clinical course of 16 HBsAg-positive renal transplant patients (M : F = 13 : 3) treated with lamivudine for chronic hepatitis B. The outcome of prophylactic (HBV-DNA negative, n=5) and preemptive (HBV-DNA positive, n=4) therapy without hepatic dysfunction was analyzed in compared with that of salvage (n=7) therapy for post-transplantation hepatic dysfunction.
Results
: Chronic hepatitis developed in four (25%) of the enrolled 16 recipients, including one fulminant hepatic failure in prophylactic group and one hepatocellular carcinoma in the salvage group. We found that three (33%) of 9 patients under prophylactic and preemptive therapy showed post-transplantation hepatic dysfunction, but that only one (14%) of 7 patients showed elevated liver enzyme after salvage therapy. During a mean follow-up, under prophylactic and preemptive therapy, of 38 months, five (56%) of 9 patients showed resistance to lamivudine. In seven patients under salvage therapy for a mean follow-up of 26 months, only one patient (14%) showed resistance. At the last follow-up, liver enzyme levels were normal in 14 patients (87.5%).
Conclusion
: It may be beneficial to use lamivudine for the prevention of liver-related mortality in renal transplant recipients with HBs-Ag positivity. Prophylactic and preemptive lamivudine therapy tend to show higher viral resistance compared with salvage therapy. |
| Key Words:
Renal transplantation, Hepatitis B virus, Lamivudine |
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