Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec;16(4):1094-1100.
doi: 10.4314/ahs.v16i4.27.

Post-transplant withdrawal of lamivudine results in fatal hepatitis flares in kidney transplant recipients, under immune suppression, with inactive hepatitis B infection

Bin Miao  1 , Xiang-Ming Lao  2 , Guo-Li Lin  3
Affiliations

Post-transplant withdrawal of lamivudine results in fatal hepatitis flares in kidney transplant recipients, under immune suppression, with inactive hepatitis B infection

Bin Miao et al. Afr Health Sci. 2016 Dec.

Abstract

Objective: To evaluate the consequences of lamivudine withdrawal in kidney transplant recipients, under immunosuppression, with inactive hepatitis B virus (HBV) infection.

Introduction: HBV infection is more frequent in kidney transplant recipients than in the general population mainly due to the high risk of acquisition during dialysis, before kidney transplantation.

Methods: The records of hepatitis B surface antigen (HBsAg)-positive, immunosuppressed kidney transplant recipients, where lamivudine was withdrawn after transplantation along with reduction in immunosuppressant dose, admitted to our hospital between 2005 and 2012, were retrospectively evaluated.

Discussion: Three patients aged 33, 42 and 33, experienced hepatitis flares 2-3 months after lamivudine withdrawal. Serum HBV DNA levels were 2.5×107, 3.4×104 and 4×103 IU/ml in cases 1, 2, and 3, respectively. Lamivudine was re-initiated in all cases which led to rapid viral suppression. However, liver function continued to deteriorate leading to severe jaundice, coagulopathy and encephalopathy. All patients died of acute liver failure within six months after the onset of withdrawal hepatitis.

Conclusion: Lamivudine should be continued as long as immunosuppressive therapy lasts.

Keywords: Hepatitis B virus; kidney transplantation; lamivudine.

PubMed Disclaimer

Figures

Figure1
Figure1
Alanine aminotransferase levels during hospitalization. Alanine aminotransferase (ALT) levels measured on day 0, 3, 6 and 12 in case 1 and 2, in addition on day 30, 60 and 90 in case 3. ALT levels peaked on day 0 in case 1 (122IU/L) and 3 (273IU/L) and on day 12 in case 2 (253IU/L)
Figure 2
Figure 2
Total bilirubin levels during hospitalization. Total bilirubin (TB) levels peaked on day 12 in case 1 (39.6mg/dl) and 2 (28.7mg/dl), and on day 30 in case 3 (38.3mg/dl).
Figure 3
Figure 3
International normalized ratio levels during hospitalization. International normalized ratio (INR) levels peaked on day 12 in case 1 (5.16) and case 2 (4.24), and on day 60 in case 3 (3.84).
Figure 4
Figure 4
Serum creatinine levels during hospitalization. Serum creatinine levels peaked on day 12 for case 1 (6.3mg/dl) and case 2 (4.1 mg/dl), on day 60 in case 3 (2.1mg/dl).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Liaw YF, Chu CM. Hepatitis B virus infection. Lancet [Research Support, Non-U.S. Gov't] 2009 Feb 14;373(9663):582–592. - PubMed
    1. Liang X, Bi S, Yang W, Wang L, Cui G, Cui F, et al. Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination. Vaccine [Research Support, Non-U.S. Gov't] 2009 Nov 5;27(47):6550–6557. - PubMed
    1. Kalia H, Fabrizi F, Martin P. Hepatitis B virus and renal transplantation. Transplant Rev (Orlando) [Review] 2011 Jul;25(3):102–109. - PubMed
    1. Chan TM, Chapman J, Lee CJ, Morad Z, Ona ET, Park K, et al. A survey on the prevalence and management of hepatitis B after renal transplantation in Asian-Pacific countries. Transplant Proc [Multicenter Study] 2004 Sep;36(7):2126–2127. - PubMed
    1. Cosconea S, Fontaine H, Meritet JF, Corouge M, Sogni P, Vallet-Pichard A, et al. Benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infection. J Hepatol. 2012 Jul;57(1):55–60. - PubMed

MeSH terms

LinkOut - more resources