Improved Outcome of Chronic Hepatitis B After Heart Transplantation by Long-Term

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From Journal of Viral Hepatitis

Improved Outcome of Chronic Hepatitis B After Heart Transplantation by

Long-Term Antiviral Therapy

Posted 12/18/2006

A. Potthoff; H. L. Tillmann; C. Bara; K. Deterding; K. Pethig; S. Meyer; A.

Haverich; K. H. W. Böker; M. P. Manns; H. Wedemeyer

Summary and Introduction

Summary

Chronic hepatitis B progresses to cirrhosis in the majority of

immunosuppressed patients. The outcome of long-term antiviral therapy in

HBV-infected organ transplant recipients is unknown. In 1996, we included 20

heart transplant (HT) recipients in a pilot trial to treat chronic hepatitis

B with famciclovir. At that time, bridging fibrosis or cirrhosis was evident

in 15 individuals (75%). From 1998 onwards, patients were switched to

lamivudine in case of primary or secondary virological nonresponse to

famciclovir. Adefovir or tenofovir became available at our centre for HT

recipients in 2002. After 103 months, one patient was still on famciclovir

showing a complete virological response. Sixteen patients were switched to

lamivudine after 0.5–4 years of famciclovir therapy. Six of those showed a

long-term response to lamivudine therapy lasting for up to 7 years.

Lamivudine resistance developed in the remaining 10 patients (63%), in 4 of

them successful rescue therapy (adefovir n = 3, tenofovir n = 1) could be

initiated. Only one hepatocellular carcinoma developed, which was

successfully treated by locoregional ablative therapy. Nine patients died

(45%), with lamivudine-resistance-related liver failure as the cause of

death in five cases. Significant improvement of Ishak fibrosis scores could

be demonstrated in six of the seven patients with more than two sequential

liver biopsies available. Long-term antiviral therapy of chronic hepatitis B

can lead to regression of liver cirrhosis in patients after organ

transplantation, unless viral resistance occurs. This study demonstrates the

urgent need for further antivirals to overcome antiviral resistance.

http://www.medscape.com/viewarticle/547948?src=mp

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