Efficacy and tolerability of lamivudine in hepatitis B infected renal transplant recipients: A single center study.

Hepatitis B virus (HBV) infection in patients on hemodialysis and renal transplantation (RT) usually has an unfavorable course. Lamivudine is a synthetic nucleoside analog with a potent action on HBV replication. There is limited data on lamivudine in renal transplant patients with HBV infection and no published report from India. Present study reports on lamivudine therapy in these patients. Patients with HBV infection taken for RT were included. Hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), HBV-DNA, and liver biopsy before RT were done in all patients. Lamivudine was given in the dose of 50 mg daily during the dialysis and 100 mg daily following successful transplant. Response was evaluated at one year. Of the 739 adult RTs during study period, 35 (4.7%) had HBV infection. Mean age of patients was 30.7 +/- 9.8 (16-55 years) and 88.5% were males. Four (11.4%) patients had HCV coinfection. HCV was not treated in any patient. All patients were HBsAg and HBV-DNA positive, while 27 (77%) were HBeAg positive. Mean ALT was 77.8 +/- 90 IU/dl; 11 (31.4%) patients had normal ALT. Mean liver biopsy grade was 5.2 +/- 1.5 (3-9) and stage was 0.7 +/- 0.6 (0-2). At one year following transplantation, ALT was normal in 27 (77%) cases, HBV-DNA undetectable in 16 (45.7%), HBeAg and HBsAg seroconversion in 8 (22.8%), and 3 (8.6%) cases, respectively. All patients tolerated the drug without any significant side effects. Treatment with lamivudine in dialysis and renal transplant patients is well tolerated and safe with efficacy comparable to patients with normal renal function.