title: Successful treatment of fibrosing cholestatic hepatitis using adefovir dipivoxil in a patient with cirrhosis and renal insufficiency.
abstract: Fibrosing cholestatic hepatitis is a deleterious manifestation of hepatitis B virus infection in immunocompromised patients. Without treatment, this condition is usually fatal within weeks of onset. Liver retransplantation has not been successfully performed to date, and treatment intervention was generally unsuccessful before the advent of adefovir dipivoxil. However, concerns have been expressed about the use of this agent in patients who are renally compromised. A 40-year-old liver transplant recipient with hepatitis B virus reinfection, resistance to lamivudine, and fibrosing cholestatic hepatitis complicated by terminal renal impairment and spontaneous bacterial peritonitis was treated with adefovir dipivoxil 10 mg after every dialysis. Since initiating treatment with adefovir dipivoxil 10 mg, a dramatic virologic and clinical improvement was observed in this patient. The patient returned to work full-time within 6 months of starting adefovir dipivoxil without the need for liver retransplantation. Serum HBV DNA (Amplicor HBV; Roche Diagnostics, Basle, Switzerland) decreased by 6 log(10) copies/mL and became negative (< 400 copies/mL) within 8 weeks of treatment and remains negative at the last available assessment. The patient continues to require renal dialysis, but is generally well. Creatinine clearance improved from 8 mL/min to 16 mL/min during the course of treatment. No adverse events related to adefovir dipivoxil were observed. Adefovir dipivoxil resulted in significant clinical improvement in this patient with hepatitis B virus-induced fibrosing cholestatic hepatitis, despite the presence of renal impairment and lamivudine resistance.
authors.affiliation: Department of Gastroenterology, Hepatology, and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Tillmann
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Bock
authors.forename: Jörg S
authors.initials: JS
authors.lastname: Bleck
authors.forename: Jens
authors.initials: J
authors.lastname: Rosenau
authors.forename: Klaus H W
authors.initials: KH
authors.lastname: Böker
authors.forename: Hannelore
authors.initials: H
authors.lastname: Barg-Hock
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Peer
authors.initials: P
authors.lastname: Flemming
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001424:Bacterial Infections; D002779:Cholestasis / Q000209:etiology* / Q000473:pathology; D004352:Drug Resistance, Microbial; D005355:Fibrosis; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006515:Hepatitis B virus / Q000502:physiology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D063065:Organophosphonates; D010538:Peritonitis / Q000150:complications / Q000382:microbiology; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil