title: Seroconversion after the addition of famciclovir therapy in a child with hepatitis B virus infection after liver transplantation who developed lamivudine resistance.
abstract: There is very little information about hepatitis B virus (HBV) infection in children after liver transplantation. This is the first report of the addition of famciclovir in a child who developed lamivudine resistance.A 5-year-old boy who was serum HBsAg-negative and was not vaccinated against HBV underwent living-related liver transplantation for fulminant hepatitis A. The donor was his mother, who was serum HBcAb-positive. No immunoprophylaxis was administered. HBV infection developed after 18 months and was treated with 3 mg/kg daily of lamivudine. Serum alanine aminotransferase normalized and HBV DNA load decreased significantly. Sixteen months later, lamivudine resistance developed; a mutation (M552I) was confirmed by sequencing through the YMDD locus of the HBV polymerase gene. The addition of 750 mg daily of famciclovir led to seroconversion and the disappearance of serum HBV DNA. Lamivudine in combination with famciclovir might be a therapeutic option for HBV reinfection after liver transplantation, also in children. Suppression of viral replication to undetectable values is possible even in the lamivudine-resistant mutant.
authors.affiliation: Pediatric Gastroenterology Institute, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
authors.forename: Rivka
authors.initials: R
authors.lastname: Shapira
authors.forename: Nilli
authors.initials: N
authors.lastname: Daudi
authors.forename: Athallia
authors.initials: A
authors.lastname: Klein
authors.forename: Daniel
authors.initials: D
authors.lastname: Shouval
authors.forename: Eytan
authors.initials: E
authors.lastname: Mor
authors.forename: Ran
authors.initials: R
authors.lastname: Tur-Kaspa
authors.forename: Gavriel
authors.initials: G
authors.lastname: Dinari
authors.forename: Z
authors.initials: Z
authors.lastname: Ben-Ari
mesh_terms: D015075:2-Aminopurine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood; D024882:Drug Resistance, Viral; D000077595:Famciclovir; D006509:Hepatitis B / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D019259:Lamivudine; D015075:2-Aminopurine; D000410:Alanine Transaminase; D000077595:Famciclovir