Twelve months of lamivudine treatment for chronic hepatitis B virus infection in renal transplant recipients

Background Chronic hepatitis B virus (HBV) infection increases morbidity and mortality in renal transplant recipients (RTR), Lamivudine has shown promising results in patients with chronic hepatitis B, but experience with its use in RTR is limited. Methods. In a prospective, open labeled, uncontrolled trial, 19 HBsAg(+) RTR were treated with lamivudine for 12 months. HBV-serologic analysis, HBV-DNA quantitation, and HBV genome sequence analysis were performed every 3 months. Results. At baseline 16 patients were HBV DNA(+), 12 patients were HBeAg(+)/Ab (-). After 3 months HBV DNA was negative in 80% of patients. In the 3 patients with elevated liver enzymes, normal values were achieved within 12 weeks. At 12 months 4 of 8 HBeAg(+)Ab(-) patients on treatment showed HBeAb, two of them with loss of HBeAg. Three patients developed mutations of the HBV polymerase gene associated with lamivudine resistance. Conclusions. Lamivudine is safe and effective in HBsAg(+) RTR, the rate of HBe-seroconversion and of lamivudine-resistance is comparable to that of nonimmunosuppressed patients.