title: Tenofovir therapy for lamivudine resistance following liver transplantation.
abstract: 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.
authors.affiliation: College of Medicine, University of Cincinnati, 231 Albert Sabin Way, MSB Room 6560, Cincinnati, OH 45267-0595, USA. Guy.Neff@uc.edu
authors.forename: Guy W
authors.initials: GW
authors.lastname: Neff
authors.forename: Jose
authors.initials: J
authors.lastname: Nery
authors.forename: Daryl Ty
authors.initials: DT
authors.lastname: Lau
authors.forename: Christopher B
authors.initials: CB
authors.lastname: O'Brien
authors.forename: Robert
authors.initials: R
authors.lastname: Duncan
authors.forename: Norah J
authors.initials: NJ
authors.lastname: Shire
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Caio
authors.initials: C
authors.lastname: Nery
authors.forename: Marzia
authors.initials: M
authors.lastname: Montalbano
authors.forename: Halim
authors.initials: H
authors.lastname: Muslu
authors.forename: Kamran
authors.initials: K
authors.lastname: Safdar
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Schiff
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
authors.forename: Juan R
authors.initials: JR
authors.lastname: Madariaga
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine