title: Lamivudine as first- and second-line treatment of hepatitis B infection after liver transplantation.
abstract: Lamivudine and famciclovir have expanded therapeutical options for HBV infection after liver transplantation. First studies confirm good antiviral effects of both, but at present the major problem seems to be a rapid resistance formation in immunosuppressed patients. Thirty-four adult patients with HBV recurrence despite passive immunoprophylaxis and seven with de novo infection after orthotopic liver transplantation (OLT) were treated with 100-150 mg lamivudine daily. Patients were either treated directly after infection (n = 14) or after breakthrough of viral replication during an initial famciclovir therapy (n = 27). All patients except two responded to treatment with a reduction of serum HBV-DNA of over 50%. Thirty-one patients (76%) turned HBV-DNA-negative during lamivudine therapy. Viral breakthrough was observed in 14 of these patients after 4-13 months of treatment. A total of 17 patients (40%) remained HBV-DNA-negative for more than 12 months. Only nine patients eliminated HBsAg, of which four had and an HDV coinfection. None of the HBeAg-positive patients converted to anti-HBe. Most patients showed a prompt and significant reduction of aspartate aminotransferase (ALAT) levels. No severe complications occurred. Therefore, a safe and effective therapy of HBV infection after transplantation is possible with lamivudine. Viral replication is suppressed even in patients who revealed breakthrough during famciclovir therapy. Resistance formation as a major drawback occurred in one third of the patients within the first year of treatment.
authors.affiliation: Department of General-, Visceral- and Transplant Surgery, Humboldt University of Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Seehofer
authors.forename: N
authors.initials: N
authors.lastname: Rayes
authors.forename: T
authors.initials: T
authors.lastname: Berg
authors.forename: R
authors.initials: R
authors.lastname: Neuhaus
authors.forename: A R
authors.initials: AR
authors.lastname: Müller
authors.forename: U
authors.initials: U
authors.lastname: Hopf
authors.forename: W O
authors.initials: WO
authors.lastname: Bechstein
authors.forename: P
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D015075:2-Aminopurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D000077595:Famciclovir; D006678:HIV / Q000187:drug effects; D006509:Hepatitis B / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects / Q000821:virology; D016031:Liver Transplantation / Q000502:physiology; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015075:2-Aminopurine; D000077595:Famciclovir