Abstract
841 Renal transplantation is associated with long-lasting HBV replication probably due to immunosuppression. HBV-infected kidney recipients are at risk for development of more active hepatitis, cirrhosis and, less frequently, hepatocellular carcinoma. To date, Interferon α may be the best treatment of chronic hepatitis B but has been reported to cause severe adverse events and to induce rejection. Lamivudine (3TC) is a new nucleoside analog with potent antiviral effects against HBV and has already been used with success in immunocompetent HBV infected patients (pts) or to prevent HBV reinfection of the graft in liver transplantation. 12 kidney recipients, including 9 men, with a mean age of 50 years (38 to 61), a mean time post transplantation of 11 years (2 to 22), HBV infected since 18 years (11 to 25 years) received an uninterrupted treatment by 3TC. Three pts were HCV co-infected and 41.6% were infected by precore mutant viruses. Liver biopsy was performed in all cases with a median Knodell score of 6.5 ± 2.5 (3-12). 3TC was given for a median of 9 months (range 3.5-23 months) and adapted to renal function. Rapid disappearance of serum HBV DNA was observed in 10 pts and the viral load was decreased of 98% for the last 2 pts. The disappearance of serum AgHBe was achieved in 66.7% of cases and the 2 pts who were CHILD B before 3TC therapy, converted to CHILD A score. Liver biopsy was performed in 2 pts, showing significal improvment in necroinflammatory activity. We did not observe adverse events, interaction with immunosuppressive drugs, or acute rejection. Unlike previous studies in liver transplantation, we did not observe any viral resistance to treatment. This good result could be explained by a low pretreatment HBV DNA level. In conclusion, Lamivudine is a safe and effective treatment for replicating hepatitis B in kidney recipients, with histologic improvment although therapy may have to be continued indefinitively. Effects of long term treatment and/or combination chemotherapy on viral replication and on fibrosis and hepatocellular carcinoma should be evaluated.
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