Entecavir treatment in kidney transplant recipients infected with hepatitis B

Although nucleotide/side analogs improve the clinical outcome of hepatitis B surface antigen‐positive (HBsAg+) kidney transplant recipients (KTR), a significant proportion of subjects have developed resistance to lamivudine (LAM). We retrospectively analyzed the efficacy and tolerability of entecavir (ETV) in HBsAg+ KTR at Queen Mary Hospital during 2005–2013. Twenty‐one patients (10 treatment‐naïve, 11 with LAM resistance) were included (duration of ETV treatment 34.7 ± 22.9 months, range 6–75 months). ETV treatment led to a decline of hepatitis B virus (HBV) DNA titer compared to baseline and is more significant in the treatment‐naïve group (treatment‐naïve: p = 0.028, <0.001 and <0.001; LAM‐resistant p = 0.273, 0.180, and 0.109 after 12, 24, and 36 months). The cumulative rate of HBV DNA undetectability at 12, 24, and 36 months was 60%, 100%, and 100% for treatment‐naïve group, and 27%, 45%, and 45% for LAM‐resistant group, respectively. Time‐to‐HBV DNA undetectability and time‐to‐alanine transaminase (ALT) normalization were 15.7 ± 4.6 and 12.6 ± 3.7 months for treatment‐naïve patients, and 24.5 ± 4.2 and 28.2 ± 3.5 months for those with LAM resistance. Genotypic resistance to ETV emerged after 20.0 ± 3.5 months with increase in ALT and HBV DNA in two patients with LAM resistance, but was not observed in the treatment‐naïve group. Allograft dysfunction, de novo cirrhosis, or hepatocellular carcinoma did not occur during follow‐up.