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Volume 76 - 2013 - Fasc.4 - Reviews

Lamivudine treatment for Hepatitis B in dialysis population : Case reports and literature review

It is well known that chronic hepatitis B plays a detrimental role on survival in patients on long-term dialysis and after kidney trans- plantation. The advent of nucleos(t)ide analogues offers the oppor- tunity to change the natural history of hepatitis B in patients with chronic kidney disease. We report our experience on lamivudine use in two patients with HBV-related liver disease on long-term dialysis. At the beginning, both the patients were HBsAg positive and HBeAg positive with high viral load ; after long-term lamivu- dine therapy, clearance of HBV viremia from serum was observed in both. Raised aminotransferase levels fell into the normal range and one patient experienced clearance of HBsAg by anti-HBV therapy. Tolerance to lamivudine was satisfactory and lamivudine resistance was not detected. Information on antiviral therapy with lamivudine in HBsAg positive patients on regular dialysis is -extremely- limited-;- we- identified- by- an- extensive- review- of- the -literature- five- studies- with- a- total- of- 38- unique- patients,- most- of them being renal transplant candidates. Lamivudine proved to be effective as the clearance of HBV viraemia from serum ranged between 56% and 100% ; the clearance of HBeAg from serum was less-evident-(between-37.5%-and-100%).-No-significant-side-effects due to lamivudine were observed and emergence of lamivudine- resistant strains was observed in two (5%) patients. Only a minority of-patients-experienced-HBsAg-loss-(13%).-We-conclude-that-anti- HBV treatment with a nucleoside analogue such as lamivudine gives satisfactory results in some patients on long-term dialysis. Clinical- trials- are- in- progress- to- assess- efficacy- and- safety- of- last- generation nucleos(t)ide analogues for anti-HBV therapy in dialysis population. (Acta gastroenterol. belg., 2013, 76, 423-428).


Discrepancies between clinical and autopsy diagnosis in liver transplant recipients - A case series

The utility of the autopsy in patients who have undergone prior orthotopic liver transplantation (OLT) has not previously been -defined.- We- sought- to- investigate- the- role- of- the- autopsy- in- liver transplantation by comparing the clinically derived cause of death with the autopsy cause of death in a cohort of liver transplant -recipients- at- our- institution.- This- study- was- undertaken- in- the -setting-of-declining-autopsy-rates-worldwide. Between 2006 and 2011 twenty-nine patients died who had previ- ously undergone OLT, of on whom 19 postmortem examinations were-performed.-We-retrospectively-reviewed-all-post-mortem-find- ings, and separately we examined the corresponding medical -records-to-determine-the-clinical-impression-of-the-cause-of-death. Discrepancies-between-the-post-mortem-and-clinical-findings-were categorised-according-to-a-modification-of-Goldman's-criteria.-Our case series demonstrated a discrepancy between the clinical and post-mortem-examination-(PME)-findings-in-54%-of-patients.-Two patients-had-major-diagnoses-(Goldman-Class-1)-not-detected-clini- cally and in seven patients the PME revealed additional undetected minor- diagnoses.- This- case- series- demonstrates- that,- even- in- the modern era of advanced diagnostic imaging techniques, the post mortem-examination-continues-to-be-a-valuable-tool-in-confirming diagnostic accuracy and improving standards in the care of liver transplant-recipients.-(Acta gastroenterol. belg., 2013, 76, 429-432).