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Article: Long-term outcome of renal transplant recipients with chronic hepatitis B infection-impact of antiviral treatments

TitleLong-term outcome of renal transplant recipients with chronic hepatitis B infection-impact of antiviral treatments
Authors
KeywordsHepatitis B
Kidney transplantation
Lamivudine
Resistance
Issue Date2010
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.transplantjournal.com
Citation
Transplantation, 2010, v. 90 n. 3, p. 325-330 How to Cite?
AbstractBackground: Antiviral treatment has improved the short-term outcome of kidney transplant recipients with chronic hepatitis B infection, but its long-term impact, especially in patients who have developed drug resistance, remains uncertain. Methods: Sixty-three hepatitis B surface antigen positive (HBsAg+) and 63 HBsAg-patients who have undergone kidney transplantation from 1985 to 2008 were retrospectively reviewed and their clinical outcomes were compared. Results: With lamivudine as initial treatment, 62% of patients developed drug resistance after 4 years. Lamivudine resistance was associated with a higher incidence of chronic hepatitis but had no significant impact on liver stiffness score or patient survival during follow-up. Salvage treatment with adefovir or entecavir was well tolerated, and resulted in a three-log decrease in hepatitis B deoxynucleic acid after 6 months and normalization of alanine aminotransferase in 75% of patients. The survival rate of HBsAg+ patients transplanted in the recent era of antiviral treatment was 81% at 10 years. Treatment of hepatitis B with nucleoside/nucleotide analogues resulted in significantly improved patient survival (83% vs. 34% at 20 years, P=0.006). Although antiviral treatment was associated with reduced mortality because of liver complications (P=0.036), liver-related deaths still accounted for 40% of mortalities in HBsAg+ patients in the era of antiviral therapies and 22.2% of all deaths that occurred in patients who had received antiviral treatment. Conclusion: Treatment of HBsAg+ renal transplant recipients with nucleoside/nucleotide analogues confers long-term survival benefit, and that rescue therapy with adefovir or entecavir is effective and well tolerated in patients who had developed resistance to lamivudine. © 2010 by World Health Organization.
Persistent Identifierhttp://hdl.handle.net/10722/129293
ISSN
2015 Impact Factor: 3.69
2015 SCImago Journal Rankings: 1.699
ISI Accession Number ID
Funding AgencyGrant Number
Wai Hung Charity Foundation
Funding Information:

Supported by the Wai Hung Charity Foundation (S.Y.).

References

 

DC FieldValueLanguage
dc.contributor.authorYap, DYHen_HK
dc.contributor.authorTang, CSOen_HK
dc.contributor.authorYung, Sen_HK
dc.contributor.authorChoy, BYen_HK
dc.contributor.authorYuen, MFen_HK
dc.contributor.authorChan, TMen_HK
dc.date.accessioned2010-12-23T08:34:47Z-
dc.date.available2010-12-23T08:34:47Z-
dc.date.issued2010en_HK
dc.identifier.citationTransplantation, 2010, v. 90 n. 3, p. 325-330en_HK
dc.identifier.issn0041-1337en_HK
dc.identifier.urihttp://hdl.handle.net/10722/129293-
dc.description.abstractBackground: Antiviral treatment has improved the short-term outcome of kidney transplant recipients with chronic hepatitis B infection, but its long-term impact, especially in patients who have developed drug resistance, remains uncertain. Methods: Sixty-three hepatitis B surface antigen positive (HBsAg+) and 63 HBsAg-patients who have undergone kidney transplantation from 1985 to 2008 were retrospectively reviewed and their clinical outcomes were compared. Results: With lamivudine as initial treatment, 62% of patients developed drug resistance after 4 years. Lamivudine resistance was associated with a higher incidence of chronic hepatitis but had no significant impact on liver stiffness score or patient survival during follow-up. Salvage treatment with adefovir or entecavir was well tolerated, and resulted in a three-log decrease in hepatitis B deoxynucleic acid after 6 months and normalization of alanine aminotransferase in 75% of patients. The survival rate of HBsAg+ patients transplanted in the recent era of antiviral treatment was 81% at 10 years. Treatment of hepatitis B with nucleoside/nucleotide analogues resulted in significantly improved patient survival (83% vs. 34% at 20 years, P=0.006). Although antiviral treatment was associated with reduced mortality because of liver complications (P=0.036), liver-related deaths still accounted for 40% of mortalities in HBsAg+ patients in the era of antiviral therapies and 22.2% of all deaths that occurred in patients who had received antiviral treatment. Conclusion: Treatment of HBsAg+ renal transplant recipients with nucleoside/nucleotide analogues confers long-term survival benefit, and that rescue therapy with adefovir or entecavir is effective and well tolerated in patients who had developed resistance to lamivudine. © 2010 by World Health Organization.en_HK
dc.languageengen_US
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.transplantjournal.comen_HK
dc.relation.ispartofTransplantationen_HK
dc.subjectHepatitis Ben_HK
dc.subjectKidney transplantationen_HK
dc.subjectLamivudineen_HK
dc.subjectResistanceen_HK
dc.subject.meshAdenine - analogs and derivatives - therapeutic use-
dc.subject.meshAntiviral Agents - adverse effects - therapeutic use-
dc.subject.meshHepatitis B, Chronic - complications - diagnosis - drug therapy - mortality-
dc.subject.meshKidney Diseases - complications - surgery-
dc.subject.meshKidney Transplantation - adverse effects - mortality-
dc.titleLong-term outcome of renal transplant recipients with chronic hepatitis B infection-impact of antiviral treatmentsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0041-1337&volume=90&issue=3&spage=325&epage=330&date=2010&atitle=Long-term+outcome+of+renal+transplant+recipients+with+chronic+hepatitis+B+infection+-+impact+of+antiviral+treatments-
dc.identifier.emailYap, DYH:desmondy@hku.hken_HK
dc.identifier.emailYung, S:ssyyung@hku.hken_HK
dc.identifier.emailYuen, MF:mfyuen@hkucc.hku.hken_HK
dc.identifier.emailChan, TM:dtmchan@hku.hken_HK
dc.identifier.authorityYap, DYH=rp01607en_HK
dc.identifier.authorityYung, S=rp00455en_HK
dc.identifier.authorityYuen, MF=rp00479en_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/TP.0b013e3181e5b811en_HK
dc.identifier.pmid20562676-
dc.identifier.scopuseid_2-s2.0-77955424877en_HK
dc.identifier.hkuros178493en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77955424877&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume90en_HK
dc.identifier.issue3en_HK
dc.identifier.spage325en_HK
dc.identifier.epage330en_HK
dc.identifier.eissn1534-6080-
dc.identifier.isiWOS:000280581200018-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridYap, DYH=25958532000en_HK
dc.identifier.scopusauthoridTang, CSO=8681865300en_HK
dc.identifier.scopusauthoridYung, S=22636568800en_HK
dc.identifier.scopusauthoridChoy, BY=7003465499en_HK
dc.identifier.scopusauthoridYuen, MF=7102031955en_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK

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