Comparison of Clinical Outcomes in Hepatitis B Virus–Positive Kidney Transplant Recipients With or Without Pretransplantation Antiviral Therapy

Kim, H.G.; Kim, E.Y.; Yu, Yeong Ji; Kim, G.H.; Jeong, J.W.; Chung, Byung Ha; Yang, Chul Woo

doi:10.1016/j.transproceed.2013.01.088

Cited by 7 publications

(9 citation statements)

References 19 publications

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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: 52%

“…HBsAg positive patients transplanted without preemptive therapy had in increased mortality rate [relative risk of death, 9.7 (P < 0.001); relative risk of liver-related mortality, 68.0 (P < 0.0001) [53] . Twenty five RT candidates received pre-transplantation prophylactic/preemptive NUC therapy, 22 (88%) were treated with LAM and 3 (12%) with ETV [54] . When compared with a historical control group NUC treated patients has a significant improvement in 10 year graft (82% vs 34%) and patient (91% vs 57%) survivals.…”

Section: Ridruejo E Nuc Treatment In Rt Patientsmentioning

confidence: 99%

“…Prophylactic and preemptive therapy resulted in the same graft and patient survival, but patients receiving preemptive therapy had a higher HBV reactivation incidence. NUC treatment was independently associated with better patient survival (P = 0.005) [54] . On the contrary, a retrospective analysis using LAM in the majority of patients found no benefit of prophylactic/ preemptive treatment [55] .…”

Section: Ridruejo E Nuc Treatment In Rt Patientsmentioning

confidence: 99%

“…Several studies had shown that this antiviral effect may impact on long term graft and patients outcome [31,54,[60][61][62] . In 63 LAM treated HBsAg positive RT recipients 10-year survival rate was 81% and such results were nearly comparable to HBsAg negative patients [31] .…”

Section: Treatment Impact On Long Term Evolutionmentioning

confidence: 99%

“…There were no renal adverse effects related to ADV/TDF therapy [61] . Twenty five patients received pre-RT treatment with LAM (22 patients) and ETV (3 patients): 18 were HBV DNA undetectable (prophylactic group) and 8 were HBV DNA positive (preemptive group), and were compared to a historical control group [54] . Unadjusted 10-year graft survival rates in the treatment cohort vs historical control cohort were 81.8% and 34.3%, respectively (P = 0.003).…”

Section: Treatment Impact On Long Term Evolutionmentioning

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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