Outcomes in liver transplant recipients with hepatitis B virus: Resistance and recurrence patterns from a large transplant center over the last decade

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. T...

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Published in:Liver transplantation 2004-11, Vol.10 (11), p.1372-1378
Main Authors: Neff, Guy W., O'Brien, Christopher B., Nery, Jose, Shire, Norah, Montalbano, Marzia, Ruiz, Phillip, Nery, Ciao, Safdar, Kamran, De Medina, Maria, Tzakis, Andreas G., Schiff, Eugene R., Madariaga, Juan
Format: Article
Language:English
Subjects:
adefovir dipivoxil
Adenine - analogs & derivatives
Adenine - pharmacology
Adult
Aged
Antiviral agents
Antiviral Agents - pharmacology
Clinical trials
Disease resistance
DNA
Drug Resistance, Viral
Female
Graft Survival - drug effects
Hepatitis B - complications
Hepatitis B surface antigen
Hepatitis B virus
Humans
Immunoglobulins
Immunoglobulins - pharmacology
Lamivudine
Lamivudine - pharmacology
Liver Failure - surgery
Liver Failure - virology
Liver Transplantation
Male
medical records
Middle Aged
Organophosphonates - pharmacology
Prophylaxis
Recurrence
Retrospective Studies
Survival
Survival Analysis
tenofovir
Treatment Outcome
Viremia
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Summary: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. (Liver Transpl 2004;10:1372–1378.)
ISSN:1527-6465
1527-6473
DOI:10.1002/lt.20277