Renal Transplantation in Patient With Chronic HBV Infection
When is it safe for the patient with chronic renal failure and chronic hepatitis B virus (HBV) infection being treated with lamivudine to be cleared for kidney transplantation?

Sanaa Fageeh, MD

Because of the risk of development of severe liver disease secondary to HBV infection, many centers do not offer kidney transplantation to HBsAg-positive candidates. With the current availability of antiviral agents with activity against HBV, such as lamivudine and adefovir, more centers are offering liver transplantation to these patients. In general, the operation is performed if the virus is not in an active replicative state. Active replication of HBV is assumed when there is evidence of the presence of DNA (ie, DNA polymerase or HBeAg positivity) and liver function abnormalities. Liver biopsy is recommended by most authors to assess the degree of liver inflammation or presence of fibrosis or cirrhosis and to determine a patient's eligibility for transplantation.

These patients must remain on long-term lamivudine therapy after liver transplantation. Reactivation of HBV infection is usually observed when lamivudine is discontinued or when resistance to lamivudine develops secondary to virus mutations. Some authors recommend corticosteroid-free immunosuppression protocols after transplantation in order to reduce the risk of viral replication.