title: Efficacy and safety of tenofovir, entecavir, and telbivudine for chronic hepatitis B in heart transplant recipients.
abstract: BACKGROUND
  Treatment of chronic hepatitis B (CHB) with polymerase inhibitors is key to prevent disease flares and progression toward advanced liver disease. Efficacy and tolerability of newer agents has been reported anecdotally in transplant recipients.
  
  
  METHODS
  In this prospective, observational study, we assessed outcomes of therapy with tenofovir (TDF), entecavir (ETV), and telbivudine (LdT) in 13 heart transplant recipients (HTR) with CHB.
  
  
  RESULTS
  Most patients were hepatitis B e antigen negative, had low baseline hepatitis B virus (HBV) DNA, and normal aminotransferases. Liver biopsy showed a median fibrosis score of 1.5 (range 0-4). Glomerular filtration rate (GFR) was <50 mL/min in 7 patients (54%). Two patients were started on de novo ETV before transplant. Eleven previously treated patients were switched to TDF (n = 9) or LdT (n = 2). Median treatment duration was 33 months (range 1-71). HBV DNA remained suppressed in 6 patients and became undetectable in 5. Aminotransferases went down to the normal range in all patients, with a single flare in 1 patient. One patient lost hepatitis B surface antigen. No cases occurred of hepatic decompensation, hepatocellular carcinoma, or liver-related death. The GFR remained largely stable, and no cases of TDF-related hyper-phosphaturia were observed.
  
  
  CONCLUSIONS
  This study indicates that newer antivirals are effective and safe in HTR with CHB.
authors.affiliation: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.|Units of Infectious & Transplant Medicine, Ospedale Monaldi, Napoli, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Durante-Mangoni
authors.affiliation: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Vitrone
authors.affiliation: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Parrella
authors.affiliation: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Andini
authors.affiliation: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Iossa
authors.affiliation: Units of Infectious & Transplant Medicine, Ospedale Monaldi, Napoli, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ragone
authors.affiliation: Microbiology and Virology, Ospedale Monaldi, Napoli, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Falco
authors.affiliation: Cardiac Surgery A.O.R.N. dei Colli, Ospedale Monaldi, Napoli, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Maiello
authors.affiliation: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.|Units of Infectious & Transplant Medicine, Ospedale Monaldi, Napoli, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Utili
authors.affiliation: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Zampino
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000494:pharmacology*; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006147:Guanine / Q000031:analogs & derivatives* / Q000494:pharmacology; D016027:Heart Transplantation / Q000009:adverse effects*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000077712:Telbivudine; D000068698:Tenofovir / Q000494:pharmacology*; D013936:Thymidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D016896:Treatment Outcome; D014766:Viremia
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000077712:Telbivudine; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D013936:Thymidine
keywords: antivirals; heart transplant; hepatitis B; safety