[Post-transplant prophylaxis of the recurrence of lamivudine-resistant YMDD mutant hepatitis B virus in liver recipients].
OBJECTIVE
To evaluate the prophylactic efficacy of adefovir dipivoxil (ADV) for post-transplant recurrence of hepatitis B virus (HBV) with lamivudine-resistant YMDD mutation in liver recipients.


METHODS
From March 2004 to May 2006, 20 patients with chronic hepatitis B associated with YMDD mutant HBV prior to liver transplantation received treatment with ADV and additional intramuscular hepatitis B immunoglobulin (HBIG) for prevention of post-transplant graft reinfection. The liver function, serum HBsAg, anti-HBs (HBIG), HBeAg, anti-HBc, anti-HBe, HBV DNA and creatinine were examined in all the patients before and after the transplantation.


RESULTS
The median follow-up duration of these patients after the transplantation was 33.5 months. Nineteen patients survived and one patient died of recurrent hepatocellular carcinoma. There was significant difference in YMDD mutation rate between the patients with HBV-DNA over 10(6) copies/ml and those with HBV-DNA less than 10(6) copies/ml (12.4% vs 2.5%, P < 0.05). HBV-DNA was undetectable at 4 weeks after the transplantation in 95.0% of the patients (19/20) and at 6 months in one case. No recurrence of hepatitis B was detected by long-term regular testing of HBsAg, HBeAg and HBV-DNA. Serum creatinine increased in 1 case 1 year after the use of ADV.


CONCLUSIONS
ADV offers protection against recurrence of HBV with YMDD mutation after liver transplantation with only mild nephrotoxicity, but renal function monitoring during the use of ADV is still necessary.
Yang
Yang
Y
Liver Transplantation Center, Third Affiliated Hospital/Institute of Organ Transplantation, Sun Yat-sen University, Guangzhou 510630, China. yysysu@163.com
Yang
Yang
Y
Zhang
Jian
J
Yi
Hui-min
HM
Lu
Min-qiang
MQ
Cai
Chang-jie
CJ
Li
Xi
X
Jiang
Nan
N
Xu
Chi
C
Li
Hua
H
Wang
Gen-shu
GS
Yi
Shu-hong
SH
Zhang
Jun-feng
JF
Jiang
Hua
H
Yang
Qing
Q
Chen
Gui-hua
GH
D000328:Adult; D000368:Aged; D020816:Amino Acid Motifs; D000998:Antiviral Agents / Q000627:therapeutic use; D004259:DNA-Directed DNA Polymerase / Q000235:genetics; D024882:Drug Resistance, Viral; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D012008:Recurrence
D000998:Antiviral Agents; D019259:Lamivudine; D004259:DNA-Directed DNA Polymerase