Antiviral treatment for chronic hepatitis B infection in renal transplant recipients

Publication date: Available online 4 March 2015 Source:Hong Kong Journal of Nephrology Author(s): Desmond Y.H. Yap , Tak Mao Chan Chronic infection with hepatitis B virus (HBV) leads to adverse clinical outcomes in renal transplant recipients (RTRs) because of increased hepatic complications. The use of oral nucleos(t)ide analogs (NAs) has brought the management of HBV infection in RTRs to a new paradigm. Lamivudine (LAM) can effectively suppress HBV DNA levels, normalize liver biochemistry, and significantly improve short- and long-term patient survival in HBsAg-positive RTRs. However, it has the burden of high drug resistance. The prevention and management of drug-resistant HBV infection in RTRs has emerged as an important clinical issue. In treatment-naïve hepatitis B surface antigen (HBsAg)-positive RTRs, ETV has demonstrated high efficacy, low resistance rates, and favorable tolerability. Entecavir can also significantly improve transaminasemia in LAM-resistant patients, although the virological response is relatively modest in comparison to the virological response in treatment-naïve patients. Adefovir (ADV) and tenofovir (TDF) are viable options for LAM-resistant HBV infection in RTR; however, their use in patients with moderate to severe allograft dysfunction entails a balance between the potential risk and benefit, the appropriate dose adjustment, and allograft function monitoring for nephrotoxicity. The long-term patient survival of HBsAg-positive RTRs has s...
Source: Hong Kong Journal of Nephrology - Category: Urology & Nephrology Source Type: research