Tenofovir therapy for lamivudine resistance following liver transplantation.
BACKGROUND
Resistant hepatitis B virus (HBV) strains develop in 30% of liver transplant recipients treated with lamivudine within 2 years from the time of transplantation.


OBJECTIVE
To assess safety and outcomes of tenofovir salvage therapy for patients with lamivudine resistance in a retrospective cohort of liver-transplanted patients.


METHODS
Medical records were retrospectively evaluated for patients who received tenofovir. Data collected included demographics, HBV serologic information prior to and during tenofovir therapy, drug-related complications, and creatinine clearance. Criteria for lamivudine resistance included elevation of liver chemistries along with reappearance of hepatitis B surface antigen, hepatitis Be antigen, and/or HBV DNA.


RESULTS
Sixteen patients showed resistance to lamivudine at 10-85 months (median 26) following liver transplantation. Tenofovir 300 mg/day orally was added in 8 patients 1-66 months after the development of viral lamivudine resistance and continued for 14-26 months (median 19.3). All 8 patients experienced HBV DNA viral suppression, with 7 currently nondetectable. No adverse events were reported, and creatinine clearance was not impaired.


CONCLUSIONS
Our results suggest that tenofovir safely and markedly decreases replication of lamivudine-resistant HBV variants after liver transplantation and is another potential option for the treatment of HBV lamivudine resistance.
Neff
Guy W
GW
College of Medicine, University of Cincinnati, 231 Albert Sabin Way, MSB Room 6560, Cincinnati, OH 45267-0595, USA. Guy.Neff@uc.edu
Nery
Jose
J
Lau
Daryl Ty
DT
O'Brien
Christopher B
CB
Duncan
Robert
R
Shire
Norah J
NJ
Ruiz
Phillip
P
Nery
Caio
C
Montalbano
Marzia
M
Muslu
Halim
H
Safdar
Kamran
K
Schiff
Eugene R
ER
Tzakis
Andreas G
AG
Madariaga
Juan R
JR
D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D024882:Drug Resistance, Viral; D006509:Hepatitis B / Q000188:drug therapy*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016879:Salvage Therapy; D000068698:Tenofovir; D016896:Treatment Outcome
D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine