Response to adefovir or entecavir in renal allograft recipients with hepatitic flare due to lamivudine-resistant hepatitis B

Abstract

We studied the effects of adefovir or entecavir in six kidney transplant recipients (mean age 45.7 ± 7.8 yr) who developed hepatitic flare due to lamivudine-resistant hepatitis B virus (HBV) infection, with 18 months of follow-up. All patients had elevated alanine aminotransferase (ALT) levels and HBV DNA >105 copies/mL (median 2.15 × 108 copies/mL) at baseline. Serum creatinine and creatinine clearance levels were 137.8 ± 59.7 μmol/L and 62.6 ± 18.7 mL/min, respectively. Four patients were treated with adefovir and two with entecavir. Median HBV DNA decreased to 1.99 × 105 copies/mL (p = 0.028) after six months, 1.5 × 104 copies/mL (p = 0.043) after 12 months, and 7.35 × 104 copies/mL (p = 0.068) after 18 months of treatment. There was a corresponding improvement in ALT (34.5 ± 19.1 U/L after 18 months, p = 0.029 compared with baseline). The rate of HBV DNA suppression was variable, and three patients took over six months for the viral load to decrease to <105 copies/mL. After 18 months, HBV DNA was <105 copies/mL in four patients and <102 copies/mL in one patient. Treatment was well-tolerated and renal function remained stable. We conclude that both adefovir and entecavir are effective in the treatment of lamivudine-resistant HBV in renal allograft recpients, and the reduction of HBV DNA to <105 copies/mL could be slow. © 2009 John Wiley & Sons A/S.