Renal Transplantation in Patient With Chronic HBV Infection Being Treated With Lamivudine

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Ask the Experts about Liver Transplantation

from Medscape Transplantation

Renal Transplantation in Patient With Chronic HBV Infection Being Treated

With Lamivudine

Question

When is it safe for the patient with chronic renal failure and chronic

hepatitis B virus (HBV) infection being treated with lamivudine to be

cleared for kidney transplantation?

Sanaa Fageeh, MD

Response from Shimon Kusne, MD

Professor, Department of Medicine, Mayo Medical School, Rochester,

Minnesota; Director, Transplant, Infectious Disease, Department of Medicine,

Mayo Clinic sdale, sdale, Arizona

Because of the risk of development of severe liver disease secondary to HBV

infection, many centers do not offer kidney transplantation to

HBsAg-positive candidates.[1] With the current availability of antiviral

agents with activity against HBV, such as lamivudine and adefovir, more

centers are offering liver transplantation to these patients. In general,

the operation is performed if the virus is not in an active replicative

state. Active replication of HBV is assumed when there is evidence of the

presence of DNA (ie, DNA polymerase or HBeAg positivity) and liver function

abnormalities. Liver biopsy is recommended by most authors to assess the

degree of liver inflammation or presence of fibrosis or cirrhosis and to

determine a patient's eligibility for transplantation.

These patients must remain on long-term lamivudine therapy after liver

transplantation. Reactivation of HBV infection is usually observed when

lamivudine is discontinued[2] or when resistance to lamivudine develops

secondary to virus mutations.[3] Some authors recommend corticosteroid-free

immunosuppression protocols after transplantation in order to reduce the

risk of viral replication.

Posted 12/22/2004

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References

Ramos EL, Kasiske BL, SR, et al. The evaluation of candidates for

renal transplantation. The current practice of US transplant centers.

Transplantation. 1994;57:490-497. Abstract

Park SK, Yang WS, Lee YS, et al. Outcome of renal transplantation in

hepatitis B surface antigen-positive patients after introduction of

lamivudine. Nephrol Dial Transplant. 2001;16:2222-2228. Abstract

Fontaine H, Thiers V, Chretien Y, et al., HBV genotypic resistance to

lamivudine in kidney recipients and hemodialyzed patients. Transplantation.

2000;69:2090-2094. Abstract

Disclosure: Shimon Kusne, MD, has no significant financial interests or

relationships to disclose.