Long-term add-on therapy with adefovir in lamivudine-resistant kidney graft recipients with chronic hepatitis B

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http://ndt.oxfordjournals.org/content/early/2011/04/11/ndt.gfr174.abstract

Nephrology Dialysis Transplantation

Advance Access

10.1093/ndt/gfr174

Long-term add-on therapy with adefovir in lamivudine-resistant kidney graft

recipients with chronic hepatitis B

Pietro Lampertico1,

Mauro Viganò1,

Floriana Facchetti1,

Federica Invernizzi1,

Aroldi2,

Giovanna Lunghi3,

Pier Giorgio Messa2 and

Massimo Colombo1

+ Author Affiliations

1“A. M. and A. Migliavacca” Center for Liver Disease, 1° Division of

Gastroenterology, Department of Medicine, Fondazione IRCCS Ca’ Granda Ospedale

Maggiore Policlinico, Università di Milano, Milan, Italy

2Division of Nephrology and Dialysis, Fondazione IRCCS Ca’ Granda Ospedale

Maggiore Policlinico, Università di Milano, Milan, Italy

3Division of Hygiene, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico,

Università di Milano, Milan, Italy

Correspondence and offprint requests to: Pietro Lampertico; E-mail:

pietro.lampertico@...

Received May 16, 2010.

Accepted March 8, 2011.

Abstract

Background. To assess the long-term effectiveness and safety of adefovir (ADV)

plus lamivudine (LMV) in LMV-resistant ® kidney transplants with chronic

hepatitis B, 11 such patients were treated with add-on ADV.

Methods. Serum alanine aminotransferase, renal function and serum hepatitis B

virus (HBV) DNA levels were assessed every 3 months; ADV mutations were searched

for by INNO-LiPA HBV DR v2 assay.

Results. During 36 months (12–48), nine patients cleared serum HBV DNA with a

3-year cumulative virological response rate of 88%, without the emergence of ADV

mutations. ADV dose was reduced in six patients (55%) showing a decline of

creatinine clearance, in the absence of proximal tubulopathy.

Conclusions. In LMV-R kidney graft recipients, long-term add-on therapy with ADV

is efficacious and safe with timely adaptation of ADV dose.