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Tenofovir and kidney transplantation: case report
Yuri Battaglia1, Elena Cojocaru1, Silvia Forcellini1
1Department of Specialized Medicine, Division of Nephrology and Dialysis, St. Anna Hospital, University Ferrara, and.
Clinical Nephrology. Case Studies
|October 19, 2017
Summary
Hepatitis B virus (HBV) reactivation in kidney transplant patients can be managed. Tenofovir effectively suppressed HBV replication resistant to entecavir, but careful monitoring of renal function is crucial.
Area of Science:
- Nephrology
- Hepatology
- Virology
Background:
- Hepatitis B virus (HBV) infection is a contraindication for kidney transplantation due to immunosuppression risks.
- Antiretroviral therapies have improved outcomes for HBV-positive (HBV+) transplant candidates.
- Entecavir is a first-line treatment, with tenofovir as an alternative for resistance.
Observation:
- A kidney transplant recipient on entecavir developed HBV flare and resistance.
- The patient exhibited elevated HBV DNA, HBeAg positivity, and moderate liver fibrosis.
- Renal function and proteinuria were monitored throughout treatment.
Findings:
- Combining tenofovir with entecavir reduced HBV DNA replication.
- Subsequent tenofovir monotherapy achieved complete remission of viral replication.
- Tenofovir use was associated with renal function deterioration and increased proteinuria.
Implications:
- Tenofovir demonstrates efficacy in managing entecavir-resistant HBV in kidney transplant patients.
- Close monitoring of renal function is essential when using tenofovir post-transplant.
- This case highlights the need for individualized treatment strategies in HBV+ transplant recipients.
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