Telbivudine is associated with improvement of renal function in patients transplanted for HBV liver disease

摘要

Recent studies showed that telbivudine in patients with hepatitis B virus (HBV) infection improved their glomerular filtration rate (GFR), but data regarding its impact on renal function in liver transplant (LT) recipients are very limited. We evaluated 17 consecutive recipients who received at baseline nucleos(t)ide analogue(s) (NAs) other than telbivudine for 12months, and then they were switched to telbivudine prophylaxis for another 12months. In each patient, laboratory data including evaluation of GFR (using MDRD and CKD-EPI) were prospectively recorded. The changes in GFR (GFR) between baseline and after 12months (1st period) and between telbivudine initiation and 24months (2nd period) were evaluated. All patients remained serum HBsAg and HBV-DNA negative. GFR-MDRD at baseline, 12months and 24months were 72 +/- 18, 67.8 +/- 16 and 70.3 +/- 12mL/min, respectively, (P=0.025 for comparison between 12months and 24months). GFR at the 1st period was significantly lower, compared with GFR at the 2nd period [mean GFR-MDRD: -4.2 (range: -24-9) vs 2.5 (range: -7-22) mL/min, P=0.013; mean GFR-CKD-EPI: -4.2 (range: -19-10) vs 4.0 (range: -7-23) mL/min, P=0.004], although the serum levels of calcineurin inhibitors were similar between the two periods. A second group of recipients (n=17) who remained under the same nontelbivudine NA(s) for 24months had a decline in the mean eGFR during the total follow-up period. In conclusion, we showed that telbivudine administration in LT recipients for HBV cirrhosis was effective and it was associated with significant improvement in renal function, butthis remains to be confirmed in larger well-designed studies.