Evolution of hepatitis B management in kidney transplantation

World J Gastroenterol. 2014 Jan 14;20(2):468-74. doi: 10.3748/wjg.v20.i2.468.

Abstract

Chronic hepatitis B virus (HBV) infection adversely influences the clinical outcomes of renal transplant recipients owing to increased hepatic complications. Management of HBV infection in kidney transplant recipients presents a challenge to clinicians, especially in endemic regions. Interferon precipitates renal allograft dysfunction. Treatment with lamivudine, the first oral nucleoside analogue available, resulted in effective viral suppression, reduced liver-related complications, and improved patient survival so that medium-term data showed comparable patient survival rates between hepatitis B surface antigen-positive and HBsAg-negative kidney transplant recipients in the era of effective antiviral therapies. Entecavir has replaced lamivudine as first-line therapy for treatment-naïve subjects in view of the propensity for drug resistance with the latter. Management of HBV infection in kidney transplant patients needs to take into consideration the nephrotoxicity of nucleoside/tide analogues such as adefovir and tenofovir. Prevention of HBV-related complications in kidney transplant recipients starts much earlier prior to transplantation, with vaccination of patients with chronic kidney disease and donor-recipient matching with regard to HBV status. In addition to anti-viral treatment, patients with chronic HBV infection must have regular surveillance for liver cancer and assessment for the development of cirrhosis.

Keywords: Hepatitis B; Kidney transplantation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Biomarkers / blood
  • Drug Resistance, Viral
  • Graft Survival / drug effects
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B, Chronic / diagnosis
  • Hepatitis B, Chronic / drug therapy*
  • Hepatitis B, Chronic / mortality
  • Hepatitis B, Chronic / transmission
  • Humans
  • Kidney Transplantation* / adverse effects
  • Kidney Transplantation* / mortality
  • Patient Selection
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Biomarkers
  • Hepatitis B Surface Antigens