Lamivudine for hepatitis B infection in post-renal transplant patients: 36 month follow-up

Abstract

INTRODUCTION: Therapy with interferon-alpha is inappropriate for post-renal transplant Hepatitis B infection, as it may result in graft rejection. We assessed the efficacy of lamivudine in HBV infection among post-renal transplant patients after 36 months of treatment. METHODS: From April 1999, post-renal transplant patients with chronic HBV infection were offered treatment with lamivudine 100 mg/day. Their liver function and HBV serology were assessed 3 monthly, and HBV-DNA annually or when otherwise indicated. Post-transplant immunosuppressive therapy was not altered. RESULTS: Lamivudine treatment was started in 43 patients [M:F = 28:15; median age 41 yrs (range 28–76)]. At recruitment, all were HBsAg (+), HBV-DNA (+) and anti-Hbe (-); 35 were HBeAg (+). Serum ALT was 24–768 IU/L (median 113). 6 had hepatic decompensation and 4 died (3 from renal causes) within one month of starting lamivudine. After 12 months of treatment HBV-DNA became undetectable and ALT normalised in 30/39 (76.9%). 16/30 discontinued treatment, but all 16 became HBV-DNA (+) 3 months later; lamivudine was restarted. 32 patients completed 36 months of treatment (7 lost to follow-up). All were HBsAg (+); 23 were HBVDNA (+) - 18/23 had earlier become DNA (-) with treatment but had breakthrough HBV-DNA (+), 5/23 were HBV-DNA(+) throughout follow-up; 4 patients were HBV-DNA (-), HBeAg (-), anti-Hbe (+); and 5 were HBV-DNA (-), HBeAg (-), anti-Hbe (-). There were no side-effects attributable to lamivudine. CONCLUSIONS: Lamivudine therapy suppressed HBV-DNA in postrenal transplant patients with HBV infection on immunosuppressive therapy, but suppression was dependant on continued therapy. After 36 months of treatment few patients showed HBe seroconversion, but not eradication of infection. Breakthrough HBV-DNA (+) occurred in a significant proportion during continued treatment