Reply to: Entecavir in the treatment of chronic hepatitis B in kidney transplantation
Authors: Anaïs Vallet-Pichard, Simona Cosconea, Hélène Fontaine, Stanislas Pol
Journal: Journal of Hepatology (2011)

Entecavir in the treatment of chronic hepatitis B in kidney transplantationJournal of HepatologyVol. 56Issue 4PreviewWe have read with interest the review by Vallet-Pichard et al. published in a recent issue of the Journal [1]. In the section "Recommendation for HBV therapy" they reviewed the scarce data published on this topic. They cited the article published by Kamar et al. as the only experience with NUC therapy in renal transplantation [2]. We have published our experience with entecavir treatment in a small population of chronic HBV patients with chronic kidney disease [3]. Eleven male patients – 1 with stage 4 chronic kidney disease, 7 undergoing hemodialysis in the waiting list for a transplant, and 3 kidney transplanted recipients – were included in the study evaluation. Full-Text PDF Open AccessVIRAL hepatitis in solid organ transplantation other than liverJournal of HepatologyVol. 55Issue 2PreviewTransplantation is the best treatment for end-stage organ failure. Hepatitis virus infections, mainly hepatitis B virus (HBV) and hepatitis C virus (HCV) infections still constitute a major problem because they are common in allograft recipients and are a significant cause of morbidity and mortality after transplantation. Recently, hepatitis E virus infection has been added as an emergent cause of chronic hepatitis in organ transplantation. The prevalence of HBV and HCV infections has markedly decreased in patients who are candidates for transplantation since the introduction of screening, hygiene and prevention measures, including systematic screening of blood and organ donations, use of erythropoietin, compliance with universal hygiene rules, segregation of HBV-infected patients from non-infected patients and systematic vaccination against HBV. Full-Text PDF Open Access We thank Dr. Ridruejo et al. for their stimulating comments on our review [[1]Vallet-Pichard A. Fontaine H. Mallet V. Pol S. Viral hepatitis in solid organ transplantation other than liver.J Hepatol. 2011; 55: 474-482Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar]. Their interesting results on entecavir efficacy and safety in HBV-positive kidney transplanted or candidates for kidney transplantation patients [[2]Ridruejo E. Adrover R. Alonso C. Mando O.G. Silva M.O. Entecavir in the treatment of chronic hepatitis B in end stage renal disease and kidney transplantation.Dial Transplant. 2010; 39: 397-400Crossref Scopus (12) Google Scholar] are very convincing and confirm the recommendation of the published guidelines [3KDIGOClinical practice guideline for the care of kidney transplant recipients.Am J Transplant. 2009; 9: S52-S57Google Scholar, 4European Association for the Study of the LiverEASL Clinical Practice Guidelines: management of chronic hepatitis B.J Hepatol. 2009; 50: 227-242Abstract Full Text Full Text PDF PubMed Scopus (1481) Google Scholar]. Eleven patients (3 kidney transplanted recipients, 8 hemodialysed patients, and 1 end stage renal disease patient) were treated with entecavir during a median of 2 ± 0.86 years. First, entecavir therapy was efficient on HBV DNA levels: 6 patients (54.5%) had HBV DNA undetectable and 5 patients had a significant decrease in serum HBV DNA levels from 6.84 ± 1.45 log10 IU/ml (range 5.21–9.04) to 1.73 ± 2.11 log10 IU/ml (range 0.78–4.72) at the end of follow-up. The shorter duration of entecavir treatment in 5 patients who had detectable HBV DNA at the end of follow-up (1.06 ± 1.03 years) probably explains the lower antiviral efficacy than in 6 patients who had HBV DNA undetectable (2.33 ± 0.56 years). It would be interesting to define if the 5 lamivudine-resistant patients before the introduction of entecavir therapy were the 5 patients who had experienced a lower antiviral efficacy. Second, 7 out of 9 HBeAg-positive patients (77.7%) had an anti-HBe seroconversion during entecavir treatment and 1 of them had an anti-HBs seroconversion. Although the small cohort of patients, these findings are exciting and encouraging, as far as the authors do not find significant changes in renal function or haematological parameters. These data are concordant with others recently published in HBV lamivudine-resistant kidney transplanted patients who respond to entecavir salvage treatment [5Tse K.C. Yap D.Y. Tang C.S. Yung S. Chan T.M. Response to adefovir or entecavir in renal allograft recipients with hepatitic flare due to lamivudine-resistant hepatitis B.Clin Transplant. 2010; 24: 207-212Crossref PubMed Scopus (22) Google Scholar, 6Yap D.Y. Tang C.S. Yung S. Choy B.Y. Yuen M.F. Chan T.M. Long-term outcome of renal transplant recipients with chronic hepatitis B infection-impact of antiviral treatments.Transplantation. 2010; 90: 325-430Crossref PubMed Scopus (51) Google Scholar] or to our own experience: we have treated 45 kidney recipients, including 18 treated by entecavir alone (n = 7) or in combination with adefovir (n = 4) or tenofovir (n = 7). HBV DNA was undetectable in 93.4% of patients and more importantly viral suppression was associated with a significant improvement in kidney and patient survival as compared to our historical data (work in progress). S. Pol is a Board Member of: BMS, Boerhinger Ingelheim, Tibotec/Janssen Cilag, Gilead, Roche, Merck/Schering Plough, Abbot and GSK; received grands from BMS, Gilead, Roche, and Merck/Schering Plough; and acted as a speaker from: BMS, Boeringher Ingelheim, Tibotec/Janssen Cilag, Gilear, Roche, Merck/Schering Plough and GSK.