Outcome of renal transplantation in hepatitis B surface antigen-positive patients after introduction of lamivudine

Background. In end-stage renal disease patients with hepatitis B surface an tigen (HBsAg), the risk of hepatic dysfunction after immunosuppression repr esents a large barrier in renal transplantation. Lamivudine is a potent inh ibitor of hepatitis B virus (HBV) replication. We retrospectively investiga ted the outcome of HBsAg-positive renal transplantation recipients after la mivudine had become available. Methods. From July 1994 to August 2000, seventeen HBsAg-positive patients ( M : F = 15 : 2) received renal allografts (13 : 4 = living: cadaveric donor s). Liver function tests at the time of transplantation were normal in all patients. Pre-transplant liver biopsies performed in 15 patients demonstrat ed minimal inflammatory histology, except in three patients showing patholo gical and clinical signs of active hepatitis. Lamivudine was started pre-op eratively in these three subjects. Another seven patients were treated with lamivudine for post-operative hepatic dysfunction. The remaining seven pat ients did not develop hepatic dysfunction after transplantation. Results. Lamivudine was initially effective in decreasing serum HBV DNA tit res, and in normalizing hepatic enzymes. Lamivudine was well tolerated with out significant side effects for 35.5 +/- 8.9 months after initiation of tr eatment. HBV DNA became negative in nine patients but remained positive in one patient. Among the nine patients with initial negative conversion of HB V DNA, two developed transient positive conversion of HBV DNA and two demon strated persistent positive conversion. Among the patients with normal live r histology in the pre-transplant period. 41.6% (5/12) developed liver path ology progression after immunosuppression. All 17 patients had functioning grafts. except for one patient who developed relapsed IgA nephropathy. Conclusions. Our data showed relatively favourable outcomes in hepatitis B- positive renal transplant recipients receiving lamivudine treatment, even t hough two patients developed lamivudine resistance.