Adefovir dipivoxil therapy in liver transplant recipients for recurrence of hepatitis B virus infect

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Journal of Gastroenterology and Hepatology 22 (12),

2130–2134.doi:10.1111/j.1440-1746.2006.04609.x AbstractHEPATOLOGYAdefovir

dipivoxil therapy in liver transplant recipients for recurrence of hepatitis B

virus infection despite lamivudine plus hepatitis B immunoglobulin prophylaxis

Murat Akyildiz,*Departments of *Gastroenterology,Murat Akyildiz, Ege University

Medical School, Department of Gastroenterology, 35100, Bornova, Izmir, Turkey.

Email: akyildizmr@... Zeki Karasu,*Departments of *Gastroenterology, Murat

Zeytunlu,††General Surgery and Unal Aydin,††General Surgery and Tijen

Ozacar‡‡Microbiology, Ege University Medical School, Bornova, Izmir, Turkey and

Murat Kilic††General Surgery andDepartments of *Gastroenterology, †General

Surgery and ‡Microbiology, Ege University Medical School, Bornova, Izmir,

TurkeyMurat Akyildiz, Ege University Medical School, Department of

Gastroenterology, 35100, Bornova, Izmir, Turkey. Email:

akyildizmr@... 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. Method: 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. Conclusion: 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. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1440-1746.2006.04609.x

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