Long-term effects of prophylactic and therapeutic lamivudine treatments in hepatitis B surface antigen-positive renal allograft recipients

摘要

Background: Among hepatitis B surface antigen (HBsAg)-positive renal allograft recipients, post-transplant immunosuppression is associated with the occurrence of hepatocellular carcinoma (HCC) and liver-related complications. Lamivudine has proven beneficial in short-term post-transplant follow-up. Methods: Between 2000 and 2009, 26 adult HBsAg-positive renal allograft recipients received lamivudine prophylaxis (Group 1) and another 28 patients received therapeutic lamivudine (Group 2) due to post-transplant hepatitis B reactivation. The historical control group included 43 HBsAg-positive renal allograft recipients who did not receive lamivudine therapy (Group 3). Results: No subjects in Group 1 presented HCC or liver-related complications and the 10-year HCC incidence of Group 2 and Group 3 was 4.2 and 34 %, respectively. Furthermore, the HCC-free survival rates as well as the 10-year patient and graft survival rates of Group 1 and Group 2 were significantly higher than those of Group 3. However, the rates of liver-related complications and graft rejection of Group 2 and Group 3 were both higher than those of Group 1. Additionally, the HBV mutation-free rate of lamivudine was significantly higher in Group 1 than in Group 2. Conclusions: Lamivudine antiviral treatment, either on a prophylactic or therapeutic basis, provided long-term benefits for HBsAg-positive renal allograft recipients, in terms of reducing the occurrence of HCC and prolonging patient and graft survival. Furthermore, compared with therapeutic lamivudine, lamivudine prophylaxis appears to significantly reduce the incidence of liver-related complications, graft rejection, and lamivudine resistance.