title: Outcomes in liver transplant recipients with hepatitis B virus: resistance and recurrence patterns from a large transplant center over the last decade.
abstract: 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.
authors.affiliation: Center for Liver Diseases, Department of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA. Guy.Neff@uc.edu
authors.forename: Guy W
authors.initials: GW
authors.lastname: Neff
authors.forename: Christopher B
authors.initials: CB
authors.lastname: O'brien
authors.forename: Jose
authors.initials: J
authors.lastname: Nery
authors.forename: Norah
authors.initials: N
authors.lastname: Shire
authors.forename: Marzia
authors.initials: M
authors.lastname: Montalbano
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Ciao
authors.initials: C
authors.lastname: Nery
authors.forename: Kamran
authors.initials: K
authors.lastname: Safdar
authors.forename: Maria
authors.initials: M
authors.lastname: De Medina
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Schiff
authors.forename: Juan
authors.initials: J
authors.lastname: Madariaga
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil