Lamivudine as first- and second-line treatment of hepatitis B infection after liver transplantation

Authors

  • Daniel Seehofer,

    Corresponding author
    1. Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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  • Nada Rayes,

    1. Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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  • Thomas Berg,

    1. Department of Gastroenterology, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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  • Ruth Neuhaus,

    1. Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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  • Andrea R. Müller,

    1. Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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  • Uwe Hopf,

    1. Department of Gastroenterology, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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  • Wolf Otto Bechstein,

    1. Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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  • Peter Neuhaus

    1. Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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*Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany Fax: + 49-30-450-52900 Tel.: + 49-30-450-52001

Abstract

Abstract Lamivudine and famciclovir have expanded therapeutical options for HBV infection after liver transplantation. First studies confirm good antiviral effects of both, but at present the major problem seems to be a rapid resistance formation in immunosuppressed patients. Thirty-four adult patients with HBV recurrence despite passive immunoprophylaxis and seven with de novo infection after orthotopic liver transplantation (OLT) were treated with 100–150 mg lamivudine daily. Patients were either treated directly after infection (n= 14) or after breakthrough of viral replication during an initial famciclovir therapy (n= 27). All patients except two responded to treatment with a reduction of serum HBV-DNA of over 50%. Thirty-one patients (76%) turned HBV-DNA-negative during lamivudine therapy. Viral breakthrough was observed in 14 of these patients after 4–13 months of treatment. A total of 17 patients (40%) remained HBV-DNA-negative for more than 12 months. Only nine patients eliminated HBsAg, of which four had and an HDV coinfection. None of the HBeAg-positive patients converted to anti-HBe. Most patients showed a prompt and significant reduction of aspartate aminotransferase (ALAT) levels. No severe complications occurred. Therefore, a safe and effective therapy of HBV infection after transplantation is possible with lamivudine. Viral replication is suppressed even in patients who revealed breakthrough during famciclovir therapy. Resistance formation as a major drawback occurred in one third of the patients within the first year of treatment.

Abbreviations
ALAT

Aspartate aminotransferase

HBIg

Anti-hepatitis B-surface immoglobulin

OLT

Orthotopic liver transplantation

Ancillary