Tsai MC, Chen YT, Chien YS, Chen TC, Hu TH. Hepatitis B virus infection and renal transplantation. World J Gastroenterol 2010; 16(31): 3878-3887 [PMID: 20712048 DOI: 10.3748/wjg.v16.i31.3878]
Corresponding Author of This Article
Tsung-Hui Hu, MD, PhD, Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, China. dr.hu@msa.hinet.net
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World J Gastroenterol. Aug 21, 2010; 16(31): 3878-3887 Published online Aug 21, 2010. doi: 10.3748/wjg.v16.i31.3878
Hepatitis B virus infection and renal transplantation
Ming-Chao Tsai, Yen-Ta Chen, Yu-Shu Chien, Te-Chuan Chen, Tsung-Hui Hu
Ming-Chao Tsai, Tsung-Hui Hu, Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, China
Yen-Ta Chen, Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, China
Yu-Shu Chien, Te-Chuan Chen, Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, China
Author contributions: Tsai MC and Hu TH drafted the paper; all other authors wrote the final version.
Correspondence to: Tsung-Hui Hu, MD, PhD, Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, China. dr.hu@msa.hinet.net
Telephone: +886-7-7317123 Fax: +886-7-7322402
Received: March 11, 2010 Revised: June 1, 2010 Accepted: June 8, 2010 Published online: August 21, 2010
Abstract
Although the prevalence of chronic hepatitis B virus (HBV) infection has declined in renal transplant recipients (RTRs), it remains a relevant clinical problem with high morbidity and mortality in long-term follow up. A thorough evaluation, including liver biopsy as well as assessment of HBV replication in serum (i.e. hepatitis B e antigen and/or HBV DNA) is required before transplantation. Interferon should not be used in this setting because of low efficacy and precipitation on acute allograft rejection. The advent of effective antiviral therapies offers the opportunity to prevent the progression of liver disease after renal transplantation. However, as far as we are aware, no studies have compared prophylactic and preemptive strategies. To date, the majority of RTRs with HBV-related liver disease have had a high virological and biochemical response to lamivudine use. However, lamivudine resistance is frequent with a prolonged course of therapy. Considering long-term treatment, antiviral agents with a high genetic barrier to resistance and lack of nephrotoxicity are suggested. The optimal strategy in RTRs with HBV infection remains to be established in the near future.
