Cho J-H, Lim J-H, Park G-Y, Kim J-S, Kang Y-J, Kwon O, Choi J-Y, Park S-H, Kim Y-L, Kim H-K, Huh S, Kim C-D
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea; Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.
Transpl Infect Dis. 2014 Apr;16(2):295-303. doi: 10.1111/tid.12202. Epub 2014 Mar 17.
The optimal duration of antiviral therapy for kidney transplant recipients (KTR) with chronic hepatitis B virus (HBV) infection remains unclear. We reported the long-term outcomes after withdrawal of antiviral agent in KTR with chronic HBV infection.
We retrospectively investigated the hepatitis B surface antigen (HBsAg)-positive KTR with antiviral agents between January 2002 and January 2012. Antiviral treatments were withdrawn in patients who met all of the following 7 criteria: (i) no clinical and histologic evidence of cirrhosis, (ii) normal liver biochemistry, (iii) negative for both HBV DNA and hepatitis B envelope antigen (HBeAg), (iv) no resistance to antiviral agent, (v) antiviral therapy > 9 months, (vi) maintenance dosage of immunosuppressant for > 3 months, and (vii) no history of acute rejection during recent 6 months. All patients were followed regularly at approximately 3-6 months for liver enzyme, viral markers, and HBV DNA level after antiviral withdrawal.
Among a total of 445 KTR, 14 HBsAg-positive patients were included in this study. Antiviral agents were used, with lamivudine in 11 patients, and with adefovir, entecavir, and telbivudine in 3 patients, respectively. Discontinuation of antiviral agent was attempted in 6 (42.9%) of 14 patients who satisfied the criteria. The median duration of antiviral therapy before withdrawal was 14.3 months (range, 9-24 months). Four (66.7%) of 6 patients were successfully withdrawn and remained negative for HBV DNA for a median 60.5 months (range, 47-82 months). The baseline HBV DNA level was not related to maintenance of remission after withdrawal. Two reactivated patients resumed antiviral treatment immediately, with subsequent normalization of HBV DNA. During the follow-up, 1 patient developed hepatocellular carcinoma; however, no patient death or graft failure was reported for all HBsAg-positive KTR.
Antiviral therapy can be discontinued successfully and safely in selected KTR with chronic HBV infection, after complete suppression of HBV and sufficient duration of antiviral therapy.
对于慢性乙型肝炎病毒（HBV）感染的肾移植受者（KTR），抗病毒治疗的最佳疗程仍不明确。我们报告了慢性HBV感染的KTR停用抗病毒药物后的长期结局。
我们回顾性调查了2002年1月至2012年1月期间使用抗病毒药物的乙型肝炎表面抗原（HBsAg）阳性的KTR。符合以下所有7条标准的患者停用抗病毒治疗：（i）无肝硬化的临床和组织学证据；（ii）肝脏生化指标正常；（iii）HBV DNA和乙型肝炎e抗原（HBeAg）均为阴性；（iv）对抗病毒药物无耐药性；（v）抗病毒治疗>9个月；（vi）免疫抑制剂维持剂量>3个月；（vii）最近6个月内无急性排斥反应史。所有患者在停用抗病毒药物后约每3 - 6个月定期随访肝功能、病毒标志物和HBV DNA水平。
在总共445例KTR中，14例HBsAg阳性患者纳入本研究。使用的抗病毒药物中，11例患者使用拉米夫定，3例患者分别使用阿德福韦、恩替卡韦和替比夫定。14例符合标准的患者中有6例（42.9%）尝试停用抗病毒药物。停药前抗病毒治疗的中位疗程为14.3个月（范围9 - 24个月）。6例患者中有4例（66.7%）成功停药，HBV DNA持续阴性，中位时间为60.5个月（范围47 - 82个月）。停药后缓解的维持与基线HBV DNA水平无关。2例复发患者立即恢复抗病毒治疗，随后HBV DNA恢复正常。随访期间，1例患者发生肝细胞癌；然而，所有HBsAg阳性的KTR均未报告患者死亡或移植失败。
在慢性HBV感染的特定KTR中，在HBV完全抑制且抗病毒治疗足够疗程后，抗病毒治疗可以成功且安全地停用。
