Hepatitis B and renal transplantation: Securing the sword of Damocles

Perrillo, Robert P.

doi:10.1053/jhep.2002.36805

Cited by 22 publications

(16 citation statements)

References 32 publications

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“…Apart from avoiding severe or irreversible hepatic damage caused by HBV reactivation, which can sometimes be fatal, there is also evidence showing that early treatment might reduce the risk of inducing lamivudine resistance, which remains a real and major concern in patients receiving long‐term treatment with this drug 80 . In this context, some researchers have suggested that administering lamivudine should be commenced pre‐emptively, immediately following transplantation regardless of the HBV‐DNA level, or even before transplantation 81,82 . Nevertheless, the appropriate timing in the latter situation, except for living–related transplantation, would be difficult to determine without causing concern over the emergence of lamivudine‐resistant mutants after prolonged use.…”

Section: Pre‐renal Transplant Preparationmentioning

confidence: 99%

Hepatitis B virus infection in dialysis patients

Wong¹,

Fung

Mak³

et al. 2005

J of Gastro and Hepatol

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Hepatitis B virus (HBV) infection remains a major issue among dialysis patients. It is associated with a high risk of hepatic complication. The liver disease runs a unique clinical course in dialysis patients, as it can progress with modest hepatic inflammation and prominent fibrosis. The conventional cut-off level of serum alanine aminotransferase (ALT) for commencing antiviral therapy may prove too high and inappropriate for dialysis patients, and liver biopsy appears to be the only definitive means to establish the activity of liver disease in dialysis patients. Liver biopsy should be considered in patients with a serum ALT level that is persistently greater than 30 IU/L, or 0.75-fold the upper limit of the normal level, and/or other clinical and laboratory findings that suggest active liver disease. For antiviral treatment, preliminary reports have shown that lamivudine is effective and well tolerated in dialysis patients. However, the long-term efficacy of lamivudine and its optimal effective dose in dialysis patients remain unknown. The prevention of nosocomial transmission among dialysis patients is also important. Universal precaution measures should be strictly observed and the segregation of hepatitis B surface antigenpositive hemodialysis patients should be considered. For HBV non-immune patients, the importance of HBV vaccination should not be overemphasized. Until a new generation of highly immunogenic vaccines that are proven to be safe and effective in patients with end-stage renal disease becomes available, early vaccination before the development of end-stage renal failure remains the best way to secure immunological protection against HBV infection in dialysis patients.

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Section: Pre‐renal Transplant Preparationmentioning

confidence: 99%

Hepatitis B virus infection in dialysis patients

Wong¹,

Fung

Mak³

et al. 2005

J of Gastro and Hepatol

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“…However, in the last decade, introduction of effective oral anti-viral therapies for HBV with judicious use of immunosuppressive drugs in recipients with viral hepatitis have altered management of HBV-infected recipients (8). Using the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database, we examined outcomes of HBV-infected kidney recipients in a recent era (2001 to 2007) compared with noninfected HBV recipients.…”

Section: Introductionmentioning

confidence: 99%

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

Reddy

Sampaio

Kuo

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Pre-existing hepatitis B virus (HBV) infection has been associated in inferior renal transplant outcomes. We examined outcomes of HBVϩ renal recipients in a more recent era with availability of oral anti-viral agents.Design, setting, participants, & measurements Using the Organ Procurement Transplant Network/United Network for Organ Sharing database, we selected adult primary kidney recipients transplanted in the United States (2001 to 2007). The cohort was divided into HBVϩ (surface antigen positive, n ϭ 1346) and HBVϪ patients (surface antigen negative; n ϭ 74,335). Five-year graft survival, patient survival, hepatic failure incidence, and associated adjusted risks were compared.Results HBVϩ recipients were more frequently Asian, had a lower body mass index, and glomerulonephritis was more prevalent as the etiology of ESRD. HBVϩ recipients had less pretransplant diabetes and cardiovascular disease, were less likely a living donor recipient, and were less likely to receive steroids at discharge. Five-year patient survival was 85.3% and 85.6% and graft survival was 74.9% and 75.1% for HBVϩ and HBVϪ, respectively. HBV infection was not a risk factor for death or kidney failure, although 5-year cumulative incidence of hepatic failure was higher in HBVϩ recipients (1.3% versus 0.2%; P Ͻ 0.001), and HBVϩ was associated with 5.5-and 5.2-fold increased risk for hepatic failure in living and deceased donors, respectively, compared with HBVϪ. ConclusionsIn a recent era (2001 to 2007), HBV-infected renal recipients were not at higher risk for kidney failure or death; however, they remain at higher risk of liver failure compared with HBVϪ recipients.

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“…This is likely to be due to the late institution of nucleoside analogues when the immune mediated damage of the liver has already been established. 19 Hence it is accepted that nucleoside analogues should be administered preemptively before the onset of clinical hepatitis due to HBV virological reactivation. [19][20][21] The availability of data on the safety and efficacy of lamivudine as pre-emptive therapy for patients undergoing cytotoxic or immunosuppressive therapy has led to a consensus recommendation that all patients with chronic HBV infection should be given a short course of lamivudine while receiving cytotoxic or immunosuppressive therapy as prophylaxis against reactivation of HBV.…”

mentioning

confidence: 99%

“…19 Hence it is accepted that nucleoside analogues should be administered preemptively before the onset of clinical hepatitis due to HBV virological reactivation. [19][20][21] The availability of data on the safety and efficacy of lamivudine as pre-emptive therapy for patients undergoing cytotoxic or immunosuppressive therapy has led to a consensus recommendation that all patients with chronic HBV infection should be given a short course of lamivudine while receiving cytotoxic or immunosuppressive therapy as prophylaxis against reactivation of HBV. 12 22 But, as prolonged lamivudine therapy is associated with an increased likelihood of developing lamivudine resistant mutants, most cancer centres would aim at discontinuing or withdrawing pre-emptive lamivudine as soon as possible in order to limit the duration of antiviral therapy.…”

mentioning

confidence: 99%

Hepatitis B reactivation after withdrawal of pre-emptive lamivudine in patients with haematological malignancy on completion of cytotoxic chemotherapy

Hui

Cheung²,

Au³

et al. 2005

Gut

145

111

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Background: The hepatic outcome of hepatitis B surface antigen (HBsAg) positive patients undergoing chemotherapy after withdrawal of pre-emptive lamivudine is unknown. Aims: To examine the occurrence of hepatitis B virus (HBV) reactivation after withdrawal of pre-emptive lamivudine. Methods: Pre-emptive lamivudine was started one week before initiation of chemotherapy in 46 consecutive HBsAg positive patients and continued for the entire duration of chemotherapy. Pre-emptive lamivudine was stopped at a median 3.1 (range 3.0-3.4) months after completion of chemotherapy. Patients were longitudinally followed up after withdrawal of pre-emptive lamivudine. Results: Median time of follow up after withdrawal of lamivudine was 25.7 (range 5.7-75.7) months. Eleven of the 46 patients (23.9%) developed HBV reactivation after withdrawal of pre-emptive lamivudine. Eight of the 16 patients with high pre-chemotherapy HBV DNA (>10 4 copies/ml) compared with three of the 30 patients with low pre-chemotherapy HBV DNA (,10 4 copies/ml) developed HBV reactivation (50.0% v 10.0%, respectively; p,0.001). Hepatitis B e antigen positive patients were also more likely to develop HBV reactivation (5/11 (45.5%) v 6/35 (17.1%), respectively; p = 0.041). A high prechemotherapy HBV DNA (>10 4 copies/ml) was the most important risk factor for HBV reactivation after withdrawal of pre-emptive lamivudine on Cox proportional hazards analysis (relative risk 16.13, (95% confidence interval 2.99-87.01; p = 0.001). Conclusions: HBV reactivation is more likely to occur in patients with high pre-chemotherapy HBV DNA after withdrawal of pre-emptive lamivudine. A more prolonged course of antiviral therapy may be necessary in these patients after completion of chemotherapy in order to reduce post-chemotherapy HBV reactivation.

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Hepatitis B and renal transplantation: Securing the sword of Damocles

Cited by 22 publications

References 32 publications

Hepatitis B virus infection in dialysis patients

Hepatitis B virus infection in dialysis patients

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

Hepatitis B reactivation after withdrawal of pre-emptive lamivudine in patients with haematological malignancy on completion of cytotoxic chemotherapy

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