Lamivudine monoprophylaxis and adefovir salvage for liver transplantation in chronic hepatitis B: A seven-year follow-up study

[Guest guest]

J Med Virol. 2008 Dec 23;81(2):224-229. [Epub ahead of print]

Lamivudine monoprophylaxis and adefovir salvage for liver transplantation in

chronic hepatitis B: A seven-year follow-up study.

Limquiaco JL, Wong J, Wong VW, Wong GL, Tse CH, Chan HY, Kwan KY, Lai PB, Chan

HL.

Department of Medicine and Therapeutics and Institute of Digestive Disease, The

Chinese University of Hong Kong, Hong Kong, China.

In Asia Pacific countries, lamivudine is used frequently as the sole prophylaxis

for hepatitis B virus (HBV) recurrence after liver transplantation due to

financial consideration. The aim was to evaluate the long-term outcome of

lamivudine monoprophylaxis with adefovir salvage for liver transplantation in

chronic hepatitis B. Consecutive chronic hepatitis B patients who received liver

transplantation from 1999 to 2003 and with at least 12 months follow up were

studied. Lamivudine monotherapy was used for antiviral prophylaxis and adefovir

was added as salvage treatment for recurrence of HBV. Twenty-four patients were

followed up for 272 (76-372) weeks post-liver transplantation. HBV recurrence

developed in seven patients with cumulative probabilities of 8%, 13%, 28%, 35%,

35%, and 49% in 1, 2, 3, 4, 5, and 6 years. At the time of recurrence of HBV,

the HBV DNA level was 910,244 (363 to 9 x 10(8)) copies/ml. On direct

sequencing, four patients had rtM204I mutation and three patients HBV DNA levels

were too low for sequencing. Six patients had elevated ALT (two patients had

ALT>1,000 IU/L and jaundice) but none had hepatic encephalopathy. After adefovir

treatment for 150 (91-193) weeks, six (86%) patients had normal ALT. HBV DNA was

undetectable in two (29%) patients, 100-1,000 copies/ml in two (29%) patients

and 10,000-100,000 copies/ml in three (43%) patients on last visit. No genotypic

resistance to adefovir was detected. Lamivudine followed by adefovir salvage is

effective for prophylaxis of recurrence of HBV after liver transplantation up to

7 years. J. Med.

Virol. 81:224-229, 2009. © 2008 Wiley-Liss, Inc.

PMID: 19107976 [PubMed - as supplied by publisher]