The addition of mycophenolate mofetil for suppressing hepatitis B virus replication in liver recipients who developed lamivudine resistance--no beneficial effect.
BACKGROUND
Mycophenolate mofetil is used as an immunosuppressive agent in liver transplant recipients. Its active compound, mycophenolic acid, also inhibits the replication of Epstein-Barr virus and human immunodeficiency virus. Based on a study indicating the effectiveness of mycophenolate mofetil on hepatitis B virus (HBV) replication in infected human hepatocyte cells in culture, we examined the efficacy of mycophenolate mofetil in suppressing HBV replication in lamivudine-resistant liver allograft recipients with recurrent HBV infection.


METHODS
The study population included four liver allograft recipients (three males, one female), median age 51 years (range 41-57 years), with recurrent HBV infection who proved to be resistant to lamivudine. All received standard maintenance immunosuppression therapy. Median pretreatment serum alanine aminotransferase level was 75 mu/L (range 39-182 mu/L) and HBV DNA level (quantitative dot blot), 70 pg/ml (range: 10-5,000 pg/ml). Mycophenolate mofetil, 1.0 g p.o. twice daily, was administered for 8 weeks, concomitant with a reduction in the maintenance corticosteroid and cyclosporine doses.


RESULTS
After mycophenolate mofetil was administered, the serum alanine aminotransferase level increased in two patients, did not change in one, and decreased in one. Serum HBV DNA levels increased in three patients and decreased (nonsignficantly) in only one patient. Two patients complained of abdominal pain and nausea.


CONCLUSIONS
Mycophenolate mofetil at the dosage used is not effective in suppressing HBV replication after liver transplantation.
Ben-Ari
Z
Z
Liver Institute and Department of Medicine D, Rabin Medical Center, Petah Tiqva, Israel.
Zemel
R
R
Tur-Kaspa
R
R
D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology*; D004352:Drug Resistance, Microbial / Q000502:physiology; D005260:Female; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D019259:Lamivudine / Q000494:pharmacology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology*; D014779:Virus Replication / Q000187:drug effects
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D019259:Lamivudine; D009173:Mycophenolic Acid