Long-term data on entecavir treatment for treatment-naive or lamivudine-resistant chronic hepatitis B infection in kidney transplant recipients

Introduction Entecavir (ETV) showed short-term efficacy and safety in HBsAg-positive kidney transplant recipients (KTRs), but long-term data are lacking. Methodology We retrospectively reviewed 30 HBsAg-positive KTRs who received ETV during 2007-2017. Results Eighteen treatment-naive (Group I) and 12 lamivudine-resistant (Group II) patients received ETV for 48.4 +/- 35.2 and 66.0 +/- 26.0 months, respectively. Both groups show significant HBV DNA decline, but Group I achieved earlier undetectability after 11.9 +/- 9.6 months (compared with 28.8 +/- 24.2 months in Group II, P = .033). Group I showed higher rates of undetectable HBV DNA (89%, 94%, 94%, 100%, and 100% at 12, 24, 36, 48, and 60 months, respectively, compared with 25%, 50%, 50%, 91%, and 91% in Group II, P = .003). ALT normalized after 6.0 +/- 1.9 and 6.8 +/- 2.1 months in Group I and Group II, respectively. Four patients (33.3%) in Group II developed drug resistance (2 had persistent viraemia and 2 had virological breakthrough, at 40.3 +/- 15.0 months). Group II showed higher liver stiffness after 5 years (7.7 +/- 4.1 kPa, compared with 5.0 +/- 1.6 kPa in Group I, P = .046) and incidence of cirrhosis (4 patients [33.3%], compared with 1 [5.6%] patient in Group I, P = .049). Two patients (one in each group) developed hepatocellular carcinoma. Renal allograft function remained stable during follow-up of 63.2 +/- 33.4 months for both groups. There was no difference in patient and graft survival between two groups at 5 years (P = .62 and .36, respectively). Conclusion ETV showed favorable long-term efficacy and tolerability in treatment-naive KTRs. One-third of lamivudine-resistant subjects showed non-response or viral breakthrough after ETV treatment.