Long-term data on entecavir treatment for treatment-naive or lamivudine-resistant chronic hepatitis B infection in kidney transplant recipients.

Abstract

Entecavir (ETV) showed short-term efficacy and safety in HBsAg-positive kidney transplant recipients (KTRs), but long-term data are lacking. We retrospectively reviewed 30 HBsAg-positive KTRs who received ETV during 2007-2017. Eighteen treatment-naïve (Group I) and 12 lamivudine-resistant (Group II) patients received ETV for 48.4±35.2 and 66.0±26.0months, respectively. Both groups show significant HBV DNA decline, but Group I achieved earlier undetectability after 11.9±9.6months (compared with 28.8±24.2months in Group II, P=.033). Group I showed higher rates of undetectable HBV DNA (89%, 94%, 94%, 100%, and 100% at 12, 24, 36, 48, and 60months, respectively, compared with 25%, 50%, 50%, 91%, and 91% in Group II, P=.003). ALT normalized after 6.0±1.9 and 6.8±2.1months in Group I and Group II, respectively. Four patients (33.3%) in Group II developed drug resistance (2 had persistent viraemia and 2 had virological breakthrough, at 40.3±15.0months). Group II showed higher liver stiffness after 5years (7.7±4.1kPa, compared with 5.0±1.6kPa in Group I, P=.046) and incidence of cirrhosis (4 patients [33.3%], compared with 1 [5.6%] patient in Group I, P=.049). Two patients (one in each group) developed hepatocellular carcinoma. Renal allograft function remained stable during follow-up of 63.2±33.4months for both groups. There was no difference in patient and graft survival between two groups at 5years (P=.62 and .36, respectively). ETV showed favorable long-term efficacy and tolerability in treatment-naïve KTRs. One-third of lamivudine-resistant subjects showed non-response or viral breakthrough after ETV treatment.