title: Adefovir dipivoxil therapy in liver transplant recipients for recurrence of hepatitis B virus infection despite lamivudine plus hepatitis B immunoglobulin prophylaxis.
abstract: BACKGROUND
  Treatment of post-transplantation recurrence of hepatitis B virus (HBV) infection despite prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine combination therapy is not easy. Because HBV reinfection has a severe course and could result in graft failure in liver transplant recipients, prompt medication is essential. Herein is reported the authors' experience with adefovir dipivoxil (AD) therapy in 11 liver transplant recipients who had HBV reinfection despite the administration of lamivudine and HBIG.
  
  
  METHODS
  Two-hundred and nine patients underwent liver transplantation (100 deceased donor liver transplantations [DDLT], 109 living donor liver transplantation [LDLT]) due to chronic hepatitis B infection between April 1997 and May 2005 in Ege University Medical School, Liver Transplantation Unit. Patients had prophylaxis with lamivudine and low-dose HBIG combination after liver transplantation. Treatment of recurrence consisted of AD 10 mg once a day and lamivudine 300 mg/daily and HBIG was discontinued in those patients.
  
  
  RESULTS
  In total there were 11 HBV recurrences: five occurred in DDLT recipients and six in LDLT recipients, at a median follow up of 18 months (range, 6-48 months). In one of 11 patients, pretransplant HBV-DNA and HBeAg were positive. Three patients had a severe course and one patient had fibrosing cholestatic hepatitis. After AD treatment, HBV-DNA level decreased in all patients and became negative in seven patients. Two patients died due to hepatocellular carcinoma recurrence after 12 and 14 months of follow up. Serum creatinine level increased mildly in one patient and no other side-effect was observed, and all patients continued therapy.
  
  
  CONCLUSIONS
  Adefovir dipivoxil is a safe, effective treatment option for post-transplant HBV recurrence even among patients with fibrosing cholestatic hepatitis caused by lamivudine-resistant HBV.
authors.affiliation: Department of Gastroenterology, Ege University Medical School, Bornova, Izmir, Turkey. akyildizmr@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Akyildiz
authors.forename: Zeki
authors.initials: Z
authors.lastname: Karasu
authors.forename: Murat
authors.initials: M
authors.lastname: Zeytunlu
authors.forename: Unal
authors.initials: U
authors.lastname: Aydin
authors.forename: Tijen
authors.initials: T
authors.lastname: Ozacar
authors.forename: Murat
authors.initials: M
authors.lastname: Kilic
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy* / Q000517:prevention & control; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D007136:Immunoglobulins / Q000494:pharmacology / Q000627:therapeutic use*; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D012008:Recurrence; D012698:Serologic Tests
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil; C045213:hepatitis B hyperimmune globulin