Results on preemptive or prophylactic treatment of lamivudine in HBsAg(+) renal allograft recipients: Comparison with salvage treatment after hepaticdysfunction with HBV recurrence

Background Lamivudine has been reported to be able to stabilize liver enzym e and hepatitis B virus (HBV) replication with recurrent hepatitis that has been regarded as a frequent and major risk factor for hepatic dysfunction and chronic liver disease in renal transplant recipients. Because large num ber of hepatitis antigenemia patients among renal transplant patients exper ience recurrent hepatic dysfunction with HBV recurrence and permanent histo logical deterioration, preemptive or primary prophylactic use of lamivudine before transplantation may be more beneficial than a trial for the treatme nt of advanced hepatic dysfunction. Methods. We conducted a double arm study to compare the efficacy of lamivud ine between the preemptive (HBV DNA positive) or prophylactic (HBV DNA nega tive) trial for the maintenance of stable liver function (n=10) and the tri al for the salvage of advanced hepatic dysfunction developed after renal tr ansplantation (n=6) in hepatitis B viremia carrier renal transplant recipie nts. Results. Hepatic dysfunction with recurrent HBV antigenemia developed in 11 of 36 (30.6%) hepatitis antigenemia patients with a mean duration of 8.4 m onths (range 5-19.4 months). In six patients treated with lamivudine after hepatic dysfunction from recurrent hepatitis B viremia, serum AST and ALT l evel normalized within 1 month and HBV-DNA disappeared in all cases, HBV-DN A, however, reappeared in three (50%) without any discontinuation of lamivu dine, Liver biopsy revealed recurrent chronic active hepatitis with severe activity of fibrosis in four cases, cholestatic fibrosing hepatitis in one, and permanent cirrhotic change in one. In seven patients who had preemptiv e lamivudine treatment at 9, 6, 2, 2, 1, 0, 0 month before the transplantat ion, HBV-DNA had converted to negative with a mean follow up of 1.2 months (range 1-2 month) in all case. Three patients who had prophylactic trials w ith lamivudine have all remained HBV-DNA negative, The recurrence rate of H BV viremia in the preemptive or prophylactic lamivudine treated group is 10 .0% (1/10), which is significantly lower than that (42.3%, 11/25) in the no nlamivudine-treated group. The re-recurrence rate of HBV viremia was signif icantly higher (3/6, 50.0%) in the reactive lamivudine treated group than i n prophylactic or pre-emptive group (1/10, 10%). Conclusion. Although lamivudine treatment after hepatic dysfunction can be a sound conventional treatment modality, this preliminary study may suggest that preemptive or prophylactic trial of lamivudine before hepatic dysfunc tion might be a more effective strategy for prevention of permanent histolo gical deterioration and recurrence of hepatitis B viremia.