File Download
  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients

TitlePreemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients
Authors
Issue Date2002
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.hepatology.org/
Citation
Hepatology, 2002, v. 36 n. 5, p. 1246-1252 How to Cite?
AbstractHepatitis B surface antigen (HBsAg)-positive kidney transplant recipients have increased liver-related mortality. The impact of lamivudine treatment on patient survival, the optimal time to start treatment, and the feasibility of discontinuing treatment have not been determined. This study examined these issues with a novel management protocol. Serum hepatitis B virus (HBV) DNA levels were measured serially in HBsAg-positive kidney transplant recipients, and lamivudine was administered preemptively to patients with increasing HBV DNA levels with or without elevation of aminotransferase levels. Outcomes of patients who underwent transplantation before or after institution of this preemptive management strategy (in January 1996) were compared. Eleven de novo patients (91.7%) who underwent transplantation between 1996 and 2000 and 15 existing patients (39.5%) who underwent transplantation between 1983 and 1995 received preemptive lamivudine therapy for 32.6 ± 13.3 months. The treatment criteria were met by de novo patients at 8.4 ± 6.2 months (range, 1-18 months) after transplantation. Suppression of HBV DNA and normalization of aminotransferase levels were achieved in all treated patients, and 21.4% had hepatitis B e antigen (HBeAg) seroconversion. The survival of preemptively managed de novo transplant patients was similar to that of HBsAg-negative controls, whereas HBsAg-positive patients who underwent transplantation before January 1996 had inferior survival (relative risk of death, 9.7 [P < .001]; relative risk of liver-related mortality, 68.0 [P < .0001]. Eleven patients (40.7%) developed lamivudine resistance. Discontinuation of lamivudine was attempted in 12 low-risk patients after stabilization and was successful in 5 (41.7%). In conclusion, preemptive lamivudine therapy based on serial HBV DNA levels and clinical monitoring improved the survival of HBsAg-positive renal allograft recipients. Treatment can be discontinued safety in selected patients after stabilization to minimize the selection of drug-resistant HBV mutants.
Persistent Identifierhttp://hdl.handle.net/10722/162640
ISSN
2015 Impact Factor: 11.711
2015 SCImago Journal Rankings: 4.752
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, TMen_HK
dc.contributor.authorFang, GXen_HK
dc.contributor.authorTang, CSOen_HK
dc.contributor.authorCheng, IKPen_HK
dc.contributor.authorLai, KNen_HK
dc.contributor.authorHo, SKNen_HK
dc.date.accessioned2012-09-05T05:21:58Z-
dc.date.available2012-09-05T05:21:58Z-
dc.date.issued2002en_HK
dc.identifier.citationHepatology, 2002, v. 36 n. 5, p. 1246-1252en_HK
dc.identifier.issn0270-9139en_HK
dc.identifier.urihttp://hdl.handle.net/10722/162640-
dc.description.abstractHepatitis B surface antigen (HBsAg)-positive kidney transplant recipients have increased liver-related mortality. The impact of lamivudine treatment on patient survival, the optimal time to start treatment, and the feasibility of discontinuing treatment have not been determined. This study examined these issues with a novel management protocol. Serum hepatitis B virus (HBV) DNA levels were measured serially in HBsAg-positive kidney transplant recipients, and lamivudine was administered preemptively to patients with increasing HBV DNA levels with or without elevation of aminotransferase levels. Outcomes of patients who underwent transplantation before or after institution of this preemptive management strategy (in January 1996) were compared. Eleven de novo patients (91.7%) who underwent transplantation between 1996 and 2000 and 15 existing patients (39.5%) who underwent transplantation between 1983 and 1995 received preemptive lamivudine therapy for 32.6 ± 13.3 months. The treatment criteria were met by de novo patients at 8.4 ± 6.2 months (range, 1-18 months) after transplantation. Suppression of HBV DNA and normalization of aminotransferase levels were achieved in all treated patients, and 21.4% had hepatitis B e antigen (HBeAg) seroconversion. The survival of preemptively managed de novo transplant patients was similar to that of HBsAg-negative controls, whereas HBsAg-positive patients who underwent transplantation before January 1996 had inferior survival (relative risk of death, 9.7 [P < .001]; relative risk of liver-related mortality, 68.0 [P < .0001]. Eleven patients (40.7%) developed lamivudine resistance. Discontinuation of lamivudine was attempted in 12 low-risk patients after stabilization and was successful in 5 (41.7%). In conclusion, preemptive lamivudine therapy based on serial HBV DNA levels and clinical monitoring improved the survival of HBsAg-positive renal allograft recipients. Treatment can be discontinued safety in selected patients after stabilization to minimize the selection of drug-resistant HBV mutants.en_HK
dc.languageengen_US
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.hepatology.org/en_HK
dc.relation.ispartofHepatologyen_HK
dc.subject.meshAdulten_US
dc.subject.meshDna, Viral - Analysisen_US
dc.subject.meshDrug Resistance, Viralen_US
dc.subject.meshFemaleen_US
dc.subject.meshGraft Survival - Drug Effectsen_US
dc.subject.meshHepatitis B - Drug Therapy - Prevention & Controlen_US
dc.subject.meshHepatitis B Surface Antigens - Geneticsen_US
dc.subject.meshHepatitis B Virus - Genetics - Isolation & Purificationen_US
dc.subject.meshHumansen_US
dc.subject.meshKidney Transplantationen_US
dc.subject.meshLamivudine - Administration & Dosageen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPostoperative Complications - Drug Therapy - Virologyen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshRecurrenceen_US
dc.subject.meshReverse Transcriptase Inhibitors - Administration & Dosageen_US
dc.subject.meshTransplantation, Homologousen_US
dc.subject.meshTreatment Outcomeen_US
dc.subject.meshVirus Replication - Drug Effectsen_US
dc.titlePreemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipientsen_HK
dc.typeArticleen_HK
dc.identifier.emailChan, TM: dtmchan@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.description.naturelink_to_OA_fulltexten_US
dc.identifier.doi10.1053/jhep.2002.36156en_HK
dc.identifier.pmid12395336-
dc.identifier.scopuseid_2-s2.0-0036829841en_HK
dc.identifier.hkuros79054-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036829841&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume36en_HK
dc.identifier.issue5en_HK
dc.identifier.spage1246en_HK
dc.identifier.epage1252en_HK
dc.identifier.isiWOS:000178948800026-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK
dc.identifier.scopusauthoridFang, GX=7201871525en_HK
dc.identifier.scopusauthoridTang, CSO=8681865300en_HK
dc.identifier.scopusauthoridCheng, IKP=7102537483en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK
dc.identifier.scopusauthoridHo, SKN=36839065300en_HK
dc.customcontrol.immutablejt 130423-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats