Serum creatinine levels peaked on day 12 for case 1 (6. 3mg/dl) and case 2 (4. 1 mg/dl), on day 60 in case 3 (2. 1mg/dl). On the 10th day of hospitalization, grade IV hepatic encephalopathy developed rapidly in cases 1 and 2, where serum ammonia levels were 84 and 165 mol/l, respectively. == Hepatitis B computer virus (HBV) is a major global public health problem. There are more than 350 million chronic HBsAg carriers Worldwide, 75% of whom reside in the Asia Pacific region1. Though HBsAg carrier rate, in China, has decreased from 9. 8% in 1992 to 7. 2% in 2006 following the universal application of hepatitis B vaccination2, it is estimated that 100 million people in China are still HBsAg-positive. HBV infection is more frequent in kidney transplant recipients than in the general population mainly due to the high risk of acquisition during dialysis, before kidney transplantation3. A survey conducted in 2003 suggests that the HBsAg carrier Adrenalone HCl rate in 11 Asian-Pacific countries ranged from 2 to 10% in patients on peritoneal dialysis, 2 to 20% in patients on hemodialysis, and 1 to 25% in kidney transplant recipients4. The etiological factor, kidney transplantation, is further complicated by the use of immunosuppressants which may consequently enhance HBV replication3. Therefore , HBVinfection in kidney recipients is associated with a higher rate of liver-related morbidity and mortality5. Antiviral treatment with nucleos(t)ide analogues (NAs) that inhibit viral reverse transcriptase is recommended and has been shown to improve the prognosis of HBV infection in kidney recipients6, 7. Lamivudine was the first FDA-approved NA and in RETN spite of a high rate of drug resistance, it is still widely used in HBsAg-positive kidney recipients8. However , the optimal duration of antiviral treatment is controversial9. Data on HBV reactivation induced by lamivudine withdrawal in immunocompromised patients are scarce. The aim of this study was to evaluate the consequences of lamivudine withdrawal in kidney transplant recipients, under immunosuppression, with inactive HBV infection. == Patients and methods == We retrospectively evaluated the records of immunosuppressed kidney transplant recipients, admitted to the Department of Organ Transplantation and the Department of Infectious Diseases in our hospital between 2005 and 2012, who were also hepatitis Adrenalone HCl B surface antigen (HBsAg)-positive and where lamivudine was withdrawn after transplantation, along with the reduction in immunosuppressant dose. Three patients were identified who met the Adrenalone HCl above criteria, who were all male patients. They were all diagnosed of chronic glomerulonephritis leading to end-stage renal disease for which they were initially subjected to hemodialysis, later performed primary kidney transplantation from ABO blood type compatible cadaveric donors. Prior to kidney transplantation, all patients were seropositive intended for HBsAg, hepatitis B core antibody (HBcAb) and hepatitis B early antibody (HBeAb) for at least 6 months, and were seronegative intended for hepatitis B surface antibody (HBsAb) and hepatitis B envelope antigen (HBeAg). Serum HBV DNA of all patients was undetectable. Hepatitis C, hepatitis D, and human immunodeficiency computer virus infected subjects were not considered for the study. Alcohol consumption did not exceed 20 g daily. Liver function tests including alanine aminotransferase (ALT), total bilirubin (TB), international normalized ratio (INR), and albumin remained generally normal and stable for more than one year. All the patients were Child-Pugh score A, and had normal ultrasound liver imaging. The clinical data of these patients is listed inTable 1 . One month after kidney transplantation, serum creatinine decreased to the normal range in all three patients. == Table 1 . == Pre-transplantation clinical characteristics in HBsAg-positive kidney transplant recipients Serum HBsAg, HBsAb, HBeAg, HBeAb and HBcAb were assayed by the Abbott AxSYM Automated Immunoassay Analyzer (Abbott Diagnostics, Illinois, USA). HBV DNA was quantified using the GeneAmp 5700 Sequence Detection System (Applied Biosystems Inc., California, USA). The lower limit of detection was 200 IU/ml. The upper normal limit intended for ALT was Adrenalone HCl Adrenalone HCl 35 IU/L, and for TB was 1 . 4 mg/dl. The normal range of albumin was 3. 6 to 5. 1 g/dl. Initial intravenous pulses of methylprednisolone at doses of 0. 51. 0 g were administered within 1 hour before.