Abstract
Background Living donor liver transplantation & use of HBV core positive grafts have been employed to expand the donor pool. Hepatitis B immune globulin(HBIG) & nucleos(t)ide analogues can prevent HBV recurrence post liver transplant (LT). Renal sparing effects of Telbivudine (LdT) have been shown in LT & non-LT patients. We aim to study the efficacy of LdT in liver recipients who received HBV core positive donor grafts in preventing HBV recurrence (defined as HBsAg and/or HBV DNA negativity) and maintaining renal function. Methods Adult liver recipients transplanted for indications other than HBV who received a HBV core positive graft were identified. Patients on LdT for HBV prophylaxis were included. Liver chemistries, renal function & creatinine clearance (MDRD4), creatinine kinase (CK), immunosuppressive trough levels, HBsAg & HBV DNA levels were collected at 3 monthly intervals. Results 4 liver recipients were switched from Lamivudine to LdT for HBV prophylaxis. All patients were HBsAg negative prior to LdT switch, did not receive HBIG post LTx, and were maintained on tacrolimus-based immunosuppression as per center protocol. All patients remain free from HBV recurrence 3 months after conversion. 75% had mild to moderate renal impairment prior to LdT switch; all patients showed improvement in eGFR (1.2 - 28 ml/min/1.73m2) 3 months after conversion from LAM to LdT. Serum tacrolimus trough levels (±1.5ng/ml) were similar at LdT switch and at 3 months. There were no reports of myositis or CK elevation.Table: No Caption available.Conclusions In this novel real life experience among liver recipients transplanted for reasons other than HBV receiving a HBV core positive donor graft, LdT was shown to be effective in preventing HBV recurrence and well tolerated. Improvements in eGFR were seen in all patients. Larger randomized trials with longer follow up are needed.
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