Renal Function Improvement by Telbivudine in Liver Transplant Recipients with Chronic Kidney Disease
Wei-Chen Lee, Tsung-Han Wu, Yu-Chao Wang, Chih-Hsien Cheng, Chen-Fang Lee, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan, Ching-Song Lee, Wei-Chen Lee, Tsung-Han Wu, Yu-Chao Wang, Chih-Hsien Cheng, Chen-Fang Lee, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan, Ching-Song Lee
Abstract
Chronic renal failure is a frequent complication in liver transplantation. Telbivudine, anti-hepatitis B virus (HBV) nucleoside, can improve renal function. It is interesting if using telbivudine for prophylaxis of HBV recurrence has additional value on renal function improvement. 120 liver transplant recipients with lamivudine prophylaxis for HBV recurrence were 1 : 1 randomized into lamivudine-continuous (n = 60) and telbivudine-replacement (n = 60) groups. Fifty-eight patients in lamivudine-continuous group and 54 in telbivudine-replacement group completed the study. In telbivudine-replacement group, the estimated glomerular filtration rate (eGRF) was improved from 63.0 ± 16.3 ml/min to 72.8 ± 21.1 ml/min at 12 months after telbivudine administration (p = 0.003). Stratifying the patients according to renal function staging, the eGRF was improved from 74.7 ± 6.9 ml/min to 84.2 ± 16.6 ml/min (p = 0.002) in 32 stage II patients and from 48.2 ± 7.3 ml/min to 59.7 ± 11.8 ml/min in 20 stage III patients after 12 months of telbivudine administration (p < 0.001). Eleven (18.3%) patients with telbivudine developed polyneuritis during the trial and post hoc following-up. In conclusion, renal function was improved by telbivudine in liver transplant recipients with long-term chronic kidney disease. However, the high incidence of polyneuritis induced by telbivudine has to be closely monitored. This trial is registered with ClinicalTrials NCT02447705.
Figures
References
- Mazzaferro V., Regalia E., Doci R., et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. The New England Journal of Medicine. 1996;334(11):693–699. doi: 10.1056/NEJM199603143341104.
- Bernardi M., Gitto S., Biselli M. The MELD score in patients awaiting liver transplant: strengths and weaknesses. Journal of Hepatology. 2011;54(6):1297–1306. doi: 10.1016/j.jhep.2010.11.008.
- Malinchoc M., Kamath P. S., Gordon F. D., Peine C. J., Rank J., Ter Borg P. C. J. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864–871. doi: 10.1053/he.2000.5852.
- Kaufman D. B., Shapiro R., Lucey M. R., Cherikh W. S., Bustami R. T., Dyke D. B. Immunosuppression: practice and trends. The American Journal of Transplantation. 2004;4(supplement 9):38–53. doi: 10.1111/j.1600-6135.2004.00397.x.
- Pillai A. A., Levitsky J. Overview of immunosuppression in liver transplantation. World Journal of Gastroenterology. 2009;15(34):4225–4233. doi: 10.3748/wjg.15.4225.
- Duvoux C., Pageaux G. P. Immunosuppression in liver transplant recipients with renal impairment. Journal of Hepatology. 2011;54(5):1041–1054. doi: 10.1016/j.jhep.2010.12.001.
- Ojo A. O., Held P. J., Port F. K., et al. Chronic renal failure after transplantation of a nonrenal organ. The New England Journal of Medicine. 2003;349(10):931–940. doi: 10.1056/nejmoa021744.
- Manne V., Allen R. M., Saab S. Strategies for the prevention of recurrent hepatitis B virus infection after liver transplantation. Gastroenterology & Hepatology. 2014;10:175–179.
- Gane E. J., Angus P. W., Strasser S., et al. Lamivudine plus low-dose hepatitis B immunoglobulin to prevent recurrent hepatitis B following liver transplantation. Gastroenterology. 2007;132(3):931–937. doi: 10.1053/j.gastro.2007.01.005.
- Loomba R., Rowley A. K., Wesley R., et al. Hepatitis B immunoglobulin and lamivudine improve hepatitis B-related outcomes after liver transplantation: meta-analysis. Clinical Gastroenterology and Hepatology. 2008;6(6):696–700. doi: 10.1016/j.cgh.2008.02.055.
- Gane E. J., Deray G., Liaw Y.-F., et al. Telbivudine improves renal function in patients with chronic hepatitis B. Gastroenterology. 2014;146(1):138e5–146e5. doi: 10.1053/j.gastro.2013.09.031.
- Wang Y., Thongsawat S., Gane E. J., et al. Efficacy and safety of continuous 4-year telbivudine treatment in patients with chronic hepatitis B. Journal of Viral Hepatitis. 2013;20(4):e37–e46. doi: 10.1111/jvh.12025.
- Levey A. S., Eckardt K. U., Tsukamoto Y., et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: improving global outcomes (KDIGO) Kidney International. 2005;67(6):2089–2100. doi: 10.1111/j.1523-1755.2005.00365.x.
- Pawarode A., Fine D. M., Thuluvath P. J. Independent risk factors and natural history of renal dysfunction in liver transplant recipients. Liver Transplantation. 2003;9(7):741–747. doi: 10.1053/jlts.2003.50113.
- Wong C.-S., Lee W.-C., Jenq C.-C., et al. Scoring short-term mortality after liver transplantation. Liver Transplantation. 2010;16(2):138–146. doi: 10.1002/lt.21969.
- Dunn C. J., Wagstaff A. J., Perry C. M., Plosker G. L., Goa K. L. Cyclosporin: an updated review of the pharmacokinetic properties, clinical efficacy and tolerability of a microemulsion-based formulation (neoral)1 in organ transplantation. Drugs. 2001;61(13):1957–2016. doi: 10.2165/00003495-200161130-00006.
- Scott L. J., McKeage K., Keam S. J., Plosker G. L. Tacrolimus: a further update of its use in the management of organ transplantation. Drugs. 2003;63(12):1247–1297. doi: 10.2165/00003495-200363120-00006.
- Cárdenas A., Ginès P. Acute-on-chronic liver failure: the kidneys. Current Opinion in Critical Care. 2011;17(2):184–189. doi: 10.1097/MCC.0b013e328344b3da.
- Crespo G., Mario Z., Navasa M., Forns X. Viral hepatitis in liver transplantation. Gastroenterology. 2012;142(6):1373e1–1383e1. doi: 10.1053/j.gastro.2012.02.011.
- Qi X., Wang J.-Y., Mao R.-C., Zhang J.-M. Impact of nucleos(t)ide analogues on the estimated glomerular filtration rate in patients with Chronic hepatitis B: a prospective cohort study in China. Journal of Viral Hepatitis. 2014;22(1):46–54. doi: 10.1111/jvh.12229.
- Perrella A., Lanza A. G., Pisaniello D., Dicostanzo G., Calise F., Cuomo O. Telbivudine prophylaxis for hepatitis B virus recurrence after liver transplantation improves renal function. Transplantation Proceedings. 2014;46(7):2319–2321. doi: 10.1016/j.transproceed.2014.07.058.
- Cholongitas E., Vasiliadis T., Goulis I., et al. Telbivudine is associated with improvement of renal function in patients transplanted for HBV liver disease. Journal of Viral Hepatitis. 2015;22(7):574–580. doi: 10.1111/jvh.12362.
- Turan I., Yapali S., Bademkiran F., et al. Telbivudine in liver transplant recipients: renal protection does not overcome the risk of polyneuropathy and myopathy. Liver Transplantation. 2015;21(8):1066–1075. doi: 10.1002/lt.24131.
- Lin C.-L., Chien R.-N., Yeh C., et al. Significant renoprotective effect of telbivudine during preemptive antiviral therapy in advanced liver cancer patients receiving cisplatin-based chemotherapy: a case-control study. Scandinavian Journal of Gastroenterology. 2014;49(12):1456–1464. doi: 10.3109/00365521.2014.962604.
- Liang K., Chen Y., Hsu C., Chang M., Yeh C. Decrease of serum angiotensin converting enzyme levels upon telbivudine treatment for chronic hepatitis B virus infection and negative correlations between the enzyme levels and estimated glumerular filtration rates. Hepatitis Monthly. 2014;14(1) doi: 10.5812/hepatmon.15074.
- Lee M., Oh S., Lee H. J., et al. Telbivudine protects renal function in patients with chronic hepatitis B infection in conjunction with adefovir-based combination therapy. Journal of Viral Hepatitis. 2014;21(12):873–881. doi: 10.1111/jvh.12217.
Source: PubMed