Lamivudine therapy in renal allograft recipients with hepatitis B virus infection

Tsang, Wing Pui; Tong, K.L; Chan, Hly

doi:10.1016/s0041-1345(02)03850-2

Cited by 8 publications

(3 citation statements)

References 8 publications

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“…Lamivudine, a nucleoside analogue, inhibits HBV replication and reduces viral load, leading to clinical, biochemical, serological and histological improvement in patients with chronic hepatitis B [30–32]. Lamivudine and other nucleoside analogues are used to treat HBV reactivation in immune compromised patients, allowing completion of immunosuppressive courses [29,33,34]. Lamivudine is also effective in renal transplant patient in suppressing HBV replication and reducing liver damage [34].…”

Section: Introductionmentioning

confidence: 99%

“…Lamivudine and other nucleoside analogues are used to treat HBV reactivation in immune compromised patients, allowing completion of immunosuppressive courses [29,33,34]. Lamivudine is also effective in renal transplant patient in suppressing HBV replication and reducing liver damage [34]. However, despite the use of antiviral drugs to treat clinical hepatitis, patients may still develop fatal hepatic failure [19,29,33].…”

Section: Introductionmentioning

confidence: 99%

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Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta‐analysis

Katz

Fraser

Gafter‐Gvili

et al. 2007

Journal of Viral Hepatitis

127

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To assess the effects of prophylactic lamivudine on reactivation and mortality following immunosuppressive therapy in hepatitis B surface antigen (HBsAg)-positive patients, we performed a meta-analysis. Systematic review and meta-analysis of randomized and nonrandomized prospective controlled trials and retrospective comparative case series were identified through The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS. The primary outcomes were virological reactivation, clinical reactivation and mortality. Secondary outcomes included hepatitis B virus (HBV)-related mortality, liver histology, discontinuation or disruption of immunosuppressive therapy, lamivudine-resistant HBV strains and adverse events. A total of 21 studies were included, two of which were randomized controlled trials. Clinical and virological reactivation were significantly reduced in the lamivudine group [odds ratio (OR) 0.09; 95% confidence interval (CI) 0.05-0.15 and OR 0.04; 95% CI 0.01-0.14 respectively]. All-cause mortality was significantly reduced in the lamivudine group (OR 0.36; 95% CI 0.23-0.56) which translates to only 11 patients who need to be treated to prevent one death. Lamivudine significantly reduced HBV-related mortality, and discontinuations or disruptions of the immunosuppressive treatment. No adverse effects of lamivudine were recorded, and resistance to lamivudine occurred in low rates. We demonstrated a clear benefit of lamivudine in terms of clinical and virological HBV reactivation, overall mortality, HBV-related mortality and interruptions or discontinuations in the immunosuppressive treatment. Lamivudine should be administered prophylactically to HBsAg-positive patients who are about to receive immunosuppressive therapy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta‐analysis

Katz

Fraser

Gafter‐Gvili

et al. 2007

Journal of Viral Hepatitis

127

View full text Add to dashboard Cite

show abstract

“…Patients with end-stage renal failure and progressive hepatitis B have for a long time been contraindicated to renal transplantation [3,4], as the anti-HBV treatment available, interferon-α , was not effective in suppressing HBV in these immunocompromised patients, whereas it substantially increased the risk of graft rejection through its immunostimulant effects [5]. The advent of the oral anti-HBV nucleoside analogue lamivudine, which is devoid of immunomodulatory and nephrotoxic effects, offered new therapeutic opportunities to suppress HBV in renaltransplant patients [6]; short-term lamivudine therapy was shown to be highly effective in these patients in suppressing HBV [7][8][9][10][11][12][13][14][15][16][17]. However, the development of lamivudine-resistant strains can limit the activity of this drug [18].…”

Section: Long-term Lamivudine Monotherapy In Renaltransplant Recipients With Hepatitis-b-related Cirrhosismentioning

confidence: 99%

Long-Term Lamivudine Monotherapy in Renal-Transplant Recipients with Hepatitis-B-Related Cirrhosis

et al. 2005

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Background Chronic hepatitis B virus (HBV) infection is an important cause of morbidity and mortality in renal-transplant recipients. The aim of the study was to assess the efficacy and safety of long-term lamivudine monotherapy in renal-transplant recipients with HBV-related cirrhosis. Methods Seventeen such patients [median age: 45 years; 7 with hepatitis B e antigen (HBeAg)] received daily oral doses of 75–150 mg lamivudine for a median of 48 (range 11–81) months. All patients had baseline serum levels of HBV DNA of over 6 log copies per ml and of 10 alanine transaminase (ALT) of over 1.5 times the upper normal limit (UNL). Clinical lamivudine resistance was defined as a rebound of serum HBV DNA above 5.3 log 10 copies per ml and of serum ALT of over 1.5 times the UNL in patients who initially responded with HBV DNA levels of less than 5.3 log copies per ml and normal ALT 10 values. Controls were 14 renal-transplant patients (median age 44 years; 3 with HBeAg) with HBV-related cirrhosis, naive to any anti-HBV therapy, followed for 58 months (4–135). Results Thirteen (77%) treated patients had a persistent response throughout the study period, including three (18%) who developed genotypic resistance, compared with none of the untreated controls (77% versus 0%, P<0.0001). Four (23%) developed clinical resistance. Two of three patients with initially decompensated cirrhosis had a durable response and clinical improvement compared with the transient responder, whose liver function worsened following lamivudine resistance. Two responders developed chronic rejection requiring chronic haemodialysis. Overall, one treated patient developed liver-related complications, compared with eight untreated controls (6% versus 57%, P<0.01). Conclusions Most renal-transplant patients treated with lamivudine achieved a rapid and durable suppression of HBV, which substantially lowered the risk of liver decompensation and death.

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Lamivudine for preventing reactivation of hepatitis B infection in patients planned to undergo immunosuppressive therapy

Katz¹,

Fraser²,

Leibovici³

et al. 2005

Cochrane Database of Systematic Reviews

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Lamivudine therapy in renal allograft recipients with hepatitis B virus infection

Cited by 8 publications

References 8 publications

Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta‐analysis

Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta‐analysis

Long-Term Lamivudine Monotherapy in Renal-Transplant Recipients with Hepatitis-B-Related Cirrhosis

Lamivudine for preventing reactivation of hepatitis B infection in patients planned to undergo immunosuppressive therapy

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