Response to adefovir or entecavir in renal allograft recipients with hepatitic flare due to lamivudine-resistant hepatitis B

Tse KC, Yap DYH, Tang CSO, Yung S, Chan TM. Response to adefovir or entecavir in renal allograft recipients with hepatitic flare due to lamivudine‐resistant hepatitis B. Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01090.x © 2009 John Wiley & Sons A/S. : We studied the effects of adefovir or entecavir in six kidney transplant recipients (mean age 45.7 ± 7.8 yr) who developed hepatitic flare due to lamivudine‐resistant hepatitis B virus (HBV) infection, with 18 months of follow‐up. All patients had elevated alanine aminotransferase (ALT) levels and HBV DNA >105 copies/mL (median 2.15 × 108 copies/mL) at baseline. Serum creatinine and creatinine clearance levels were 137.8 ± 59.7 μmol/L and 62.6 ± 18.7 mL/min, respectively. Four patients were treated with adefovir and two with entecavir. Median HBV DNA decreased to 1.99 × 105 copies/mL (p = 0.028) after six months, 1.5 × 104 copies/mL (p = 0.043) after 12 months, and 7.35 × 104 copies/mL (p = 0.068) after 18 months of treatment. There was a corresponding improvement in ALT (34.5 ± 19.1 U/L after 18 months, p = 0.029 compared with baseline). The rate of HBV DNA suppression was variable, and three patients took over six months for the viral load to decrease to