Cholongitas E, Vasiliadis T, Goulis I, Fouzas I, Antoniadis N, Papanikolaou V, Akriviadis E
4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
1st Pr. Department of Internal Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Viral Hepat. 2015 Jul;22(7):574-80. doi: 10.1111/jvh.12362. Epub 2014 Nov 11.
Recent studies showed that telbivudine in patients with hepatitis B virus (HBV) infection improved their glomerular filtration rate (GFR), but data regarding its impact on renal function in liver transplant (LT) recipients are very limited. We evaluated 17 consecutive recipients who received at baseline nucleos(t)ide analogue(s) (NAs) other than telbivudine for 12 months, and then they were switched to telbivudine prophylaxis for another 12 months. In each patient, laboratory data including evaluation of GFR (using MDRD and CKD-EPI) were prospectively recorded. The changes in GFR (ΔGFR) between baseline and after 12 months (1st period) and between telbivudine initiation and 24 months (2nd period) were evaluated. All patients remained serum HBsAg and HBV-DNA negative. GFR-MDRD at baseline, 12 months and 24 months were 72 ± 18, 67.8 ± 16 and 70.3 ± 12 mL/min, respectively, (P = 0.025 for comparison between 12 months and 24 months). ΔGFR at the 1st period was significantly lower, compared with ΔGFR at the 2nd period [mean ΔGFR-MDRD: -4.2 (range: -24-9) vs 2.5 (range: -7-22) mL/min, P = 0.013; mean ΔGFR-CKD-EPI: -4.2 (range: -19-10) vs 4.0 (range: -7-23) mL/min, P = 0.004], although the serum levels of calcineurin inhibitors were similar between the two periods. A second group of recipients (n = 17) who remained under the same nontelbivudine NA(s) for 24 months had a decline in the mean eGFR during the total follow-up period. In conclusion, we showed that telbivudine administration in LT recipients for HBV cirrhosis was effective and it was associated with significant improvement in renal function, but this remains to be confirmed in larger well-designed studies.
近期研究表明，替比夫定可改善乙型肝炎病毒（HBV）感染患者的肾小球滤过率（GFR），但关于其对肝移植（LT）受者肾功能影响的数据非常有限。我们评估了17例连续的受者，他们在基线时接受除替比夫定之外的核苷（酸）类似物（NAs）治疗12个月，然后改用替比夫定预防治疗12个月。对每位患者前瞻性记录包括GFR评估（使用MDRD和CKD-EPI）在内的实验室数据。评估基线时与12个月后（第1阶段）以及替比夫定开始使用至24个月（第2阶段）之间GFR的变化（ΔGFR）。所有患者血清HBsAg和HBV-DNA均保持阴性。基线、12个月和24个月时的GFR-MDRD分别为72±18、67.8±16和70.3±12 mL/分钟，（12个月与24个月比较，P = 0.025）。与第2阶段的ΔGFR相比，第1阶段的ΔGFR显著更低[平均ΔGFR-MDRD：-4.2（范围：-24至9）vs 2.5（范围：-7至22）mL/分钟，P = 0.013；平均ΔGFR-CKD-EPI：-4.2（范围：-19至10）vs 4.0（范围：-7至23）mL/分钟，P = 0.004]，尽管两个阶段的钙调神经磷酸酶抑制剂血清水平相似。第二组受者（n = 17）在24个月内一直使用相同的非替比夫定NAs，其平均估算肾小球滤过率（eGFR）在整个随访期间下降。总之，我们表明，在LT受者中给予替比夫定治疗HBV肝硬化是有效的，并且与肾功能的显著改善相关，但这仍有待在更大规模的精心设计研究中得到证实。
