Outcomes in liver transplant recipients with hepatitis B virus: resistance and recurrence patterns from a large transplant center over the last decade.
Hepatitis B virus (HBV) recurrence following liver transplantation (LTx) has been controllable primarily with the use of hepatitis B immune globulin (HBIg) and lamivudine (LAM). However, HBV resistance to LAM and/or HBIg has become an increasing problem prompting the use of newer antiviral agents. The purpose of our study was to investigate the association between therapy, HBV breakthrough, and allograft / patient survival in HBV-positive liver transplant recipients. We performed a retrospective review of the medical records of patients that were transplanted for HBV from June 1994 to May 2003. A total of 92 patients, positive for either hepatitis B surface antigen (HBsAg) or HBV deoxyribonucleic acid (DNA) pretransplant, received LAM monotherapy or HBIg (6 months) plus LAM therapy post-liver transplant. HBV breakthrough post-LTx was noted in 14 patients. All patients had detectable HBV DNA prior to liver transplantation; none of the patients that were HBV DNA negative prior to transplant had detectable HBV DNA posttransplant. Of these 14, 9 patients (64%) were switched from LAM to adefovir dipivoxil (ADF) and 5 patients (36%) to tenofovir disoproxil fumarate (TNV). In conclusion, pre-LTx HBV viremia should be considered in planning post-LTx prophylaxis. Trials to evaluate oral antiviral agents in combination with or without HBIg therapy are needed.
Neff
Guy W
GW
Center for Liver Diseases, Department of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA. Guy.Neff@uc.edu
O'brien
Christopher B
CB
Nery
Jose
J
Shire
Norah
N
Montalbano
Marzia
M
Ruiz
Phillip
P
Nery
Ciao
C
Safdar
Kamran
K
De Medina
Maria
M
Tzakis
Andreas G
AG
Schiff
Eugene R
ER
Madariaga
Juan
J
D000225:Adenine / Q000031:analogs & derivatives* / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000494:pharmacology*; D024882:Drug Resistance, Viral; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D007136:Immunoglobulins / Q000494:pharmacology; D019259:Lamivudine / Q000494:pharmacology; D017093:Liver Failure / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000494:pharmacology; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000998:Antiviral Agents; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil