Evolution of hepatitis B management in kidney transplantation

Core Tip

Core tip: Treatment with oral nucleoside/tide analogues brought a new paradigm in the management of hepatitis B surface antigen-positive kidney transplant recipients, resulting in effective viral suppression, reduced hepatic complications, and improved patient survival, without compromising renal allograft outcome. Entecavir has replaced lamivudine as first-line therapy for treatment-naïve subjects given the propensity of lamivudine for selecting resistance. Due to the nephrotoxicity of adefovir and tenofovir, the optimal management of drug-resistant hepatitis B virus (HBV) remains to be defined. Other important measures to prevent HBV-related complications in renal transplant patients include early vaccination in non-immune subjects, donor-recipient matching of HBV status, and surveillance for liver cancer and cirrhosis.