Long‐term data on entecavir treatment for treatment‐naive or lamivudine‐resistant chronic hepatitis B infection in kidney transplant recipients

• Published in: Transplant infectious disease Vol. 21; no. 5; pp. e13143 - n/a
• Main Authors: Yap, Desmond Y. H., Tang, Colin, Fung, James Y. Y., Seto, Wai‐Kay, Ma, Maggie K. M., Choy, Bo Ying, Chan, Tak Mao
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.10.2019
• Subjects: Adult; Antiretroviral drugs; Antiviral Agents - therapeutic use; Antiviral drugs; Chronic infection; Cirrhosis; Deoxyribonucleic acid; DNA; Drug resistance; Drug Resistance, Viral; entecavir; Female; Group dynamics; Guanine - analogs & derivatives; Guanine - therapeutic use; Hepatitis B; Hepatitis B surface antigen; Hepatitis B virus - drug effects; Hepatitis B, Chronic - drug therapy; Hepatocellular carcinoma; Humans; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Kidneys; Lamivudine; Lamivudine - pharmacology; Liver cancer; Liver cirrhosis; long‐term; Male; Middle Aged; Patients; Renal cell carcinoma; Renal function; Retrospective Studies; Stiffness; Transplant Recipients; Viremia; entecavir; hepatitis B; kidney transplantation; long-term
• ISSN: 1398-2273; 1399-3062; 1399-3062
• DOI: 10.1111/tid.13143

Introduction Entecavir (ETV) showed short‐term efficacy and safety in HBsAg‐positive kidney transplant recipients (KTRs), but long‐term data are lacking. Methodology We retrospectively reviewed 30 HBsAg‐positive KTRs who received ETV during 2007‐2017. Results Eighteen treatment‐naïve (Group I) and 12 lamivudine‐resistant (Group II) patients received ETV for 48.4 ± 35.2 and 66.0 ± 26.0 months, respectively. Both groups show significant HBV DNA decline, but Group I achieved earlier undetectability after 11.9 ± 9.6 months (compared with 28.8 ± 24.2 months in Group II, P = .033). Group I showed higher rates of undetectable HBV DNA (89%, 94%, 94%, 100%, and 100% at 12, 24, 36, 48, and 60 months, respectively, compared with 25%, 50%, 50%, 91%, and 91% in Group II, P = .003). ALT normalized after 6.0 ± 1.9 and 6.8 ± 2.1 months in Group I and Group II, respectively. Four patients (33.3%) in Group II developed drug resistance (2 had persistent viraemia and 2 had virological breakthrough, at 40.3 ± 15.0 months). Group II showed higher liver stiffness after 5 years (7.7 ± 4.1 kPa, compared with 5.0 ± 1.6 kPa in Group I, P = .046) and incidence of cirrhosis (4 patients [33.3%], compared with 1 [5.6%] patient in Group I, P = .049). Two patients (one in each group) developed hepatocellular carcinoma. Renal allograft function remained stable during follow‐up of 63.2 ± 33.4 months for both groups. There was no difference in patient and graft survival between two groups at 5 years (P = .62 and .36, respectively). Conclusion ETV showed favorable long‐term efficacy and tolerability in treatment‐naïve KTRs. One‐third of lamivudine‐resistant subjects showed non‐response or viral breakthrough after ETV treatment.