Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:51pm-3:03pm
Location: Room 118-AB
Background: Lamivudine is one of the anti-hepatitis B virus (HBV) agents to prevent HBV recurrence after transplantation because lamivudine is safe for long-term use. However, nephrotoxicity is one of the adverse effects of lamivudine. This will the second hit on renal function for transplant patients who already expose to nephrotoxicity of calcineurin inhibitors. In this randomized clinical trial, lamivudine was replaced by telbivudine to see whether renal function could be improved.
Patients: 123 post-transplant hepatitis B patients with prophylaxis of HBV recurrence using lamivudine were included in this study. Their renal function was in grade 2 to 4 and liver function was stable. The patients were randomized into control (n=62) and experimental (n=61) groups. eGFR data were collected before, 6-month and 12 month after medication conversion.
Results: Totally, 58 patients in control group and 54 patients in experimental group finished the study. Four patients were withdrawn from control group due to cancer (n=2) and infection (n=2) and seven patients were withdrawn from experimental group due to polyneuritis (n=5) and infection (n=2). The ages between two groups were not different. The time from transplantation to be included in this study in two group patients was not different, either. In control group, eGFR were 61.4±16.9ml/min before the study, 62.2±16.9ml/min at 6 months, and 61.6±17.7ml/min at 12 months, respectively (p=0.721). In experimental group, eGFR were 63.0±16.3ml/min before drug conversion, 65.6±18.2ml/min at 6 months (p=0.661), and 72.7±22.1ml/min at 12 months after drug conversion, respectively (p<0.001). During the study, 5 (8.2%) patients had polyneuritis due to adverse effect of telbivudine. In the following-up after study, another 9 patients had polyneuritis with muscle weakness. After discontinuation of telbivudine, muscle weakness was reversed.
Conclusion: Telbivudine to replace lamivudine improved renal function in long-term post-transplant hepatitis B patients. However, polyneuritis with muscle weakness developed in 14 (23%) patients in long-term use of telbivudine.
To cite this abstract in AMA style:Lee W-C, Chou H-S, Soong R-S, Wu T-J, Cheng C-H, Wang Y-C, Wu T-H, Lee C-F, Chan K-M. Replacement of Lamivudine By Telbivudine to Improve Renal Function for Post-Transplant Hepatitis B Patients A Randomized Clinical Trial [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/replacement-of-lamivudine-by-telbivudine-to-improve-renal-function-for-post-transplant-hepatitis-b-patients-a-randomized-clinical-trial/. Accessed August 13, 2020.
« Back to 2015 American Transplant Congress