Transplant Trial Watch

Renal Function Improvement by Telbivudine in Liver Transplant Recipients with Chronic Kidney Disease.

Lee W, Wu T, et al.

BioMed Research International 2017:9324310.

To determine whether renal function could be improved in liver transplant recipients with lamivudine (LAM) prophylaxis for hepatitis B virus (HBV) when switched to Telbivudine (LdT).

Participants were randomised to either continue receiving LAM at one 100mg tablet per day (LAM-continuous), or were shifted from LAM to one 600mg tablet per day LdT (LdT-replacement).

120 liver transplant recipients with LAM for prophylaxis of HBV Recurrence, aged ≥ 18 years with stable liver function > 6 months and renal function in stages 2–4.

Measured outcomes included HBV recurrence, renal function, estimated glomerular filtration rate and adverse effects of LdT.

24 months

CET Conclusions
This interesting study investigates the role of switching liver transplant recipients receiving lamivudine as prophylaxis against recurrent hepatitis B to telbivudine. Telbivudine has been shown in patients receiving chronic hepatitis B treatment to improve renal function, and is therefore postulated to have a beneficial effect in liver transplant recipients on calcineurin inhibitor therapy. This open-labelled study randomised 120 stable liver transplant recipients to continue lamivudine or switch to telbivudine. Renal function remained stable in the lamivudine arm, but improved significantly in the telbivudine patients. Improvement was sustained over 18 months by up to 15-20 ml/min. Of note, 9 patients experienced significant peripheral neuropathy. Analysis was not intent-to-treat, so the real-world benefit taking into account patients unable to tolerate telbivudine therapy is likely to be smaller than that documented here.

Jadad score

Data analysis
Modified intention-to-treat analysis

Allocation concealment

Trial registration - NCT02447705

Funding source
Non-industry funded