Diminished survival due to
hepatitis B has been observed after
renal transplantation (RT).
Lamivudine, a second-generation
nucleoside analogue, has been approved for the treatment of
chronic hepatitis B virus (HBV)
infection in patients with normal renal function. Numerous clinical experiences with
lamivudine after RT have been recently published. Despite numerous shortcomings, all of these reports have shown encouraging results. The rate of clearance of HBV
viremia ranged between 67% and 100%, and the frequency of ALT normalization was between 50% and 100% with
lamivudine use. Even patients with fibrosing cholestatic
hepatitis, a serious form of HBV-related
liver disease with ominous course, have been successfully treated with
lamivudine.
Lamivudine therapy significantly improved the survival of
HBsAg positive renal allograft recipients. However, numerous issues concerning the treatment of
hepatitis B after RT remain unclear: the optimal time to initiate
lamivudine, the appropriate duration of
antiviral therapy after RT, and the role for pre-
transplantation liver biopsy. Also, the management of
lamivudine resistance remains a concern for physicians. Clinical trials are under way.