Treatment of recurrent hepatitis B infection in liver transplant recipients

liver411

Liver Transplantation
October 2002, Supplement 1 . Volume 8 . Number 10

Section III-Hepatitis B

Treatment of recurrent hepatitis B infection in liver transplant recipients

Norah A. Terrault

Abstract
1. Therapeutic decisions are guided by a patient's clinical status (severity
of disease and presence of comorbidities) and previous drug-exposure
history.
2. Lamivudine is safe and effective in liver transplant recipients with
recurrent hepatitis B virus (HBV) infection caused by wild-type virus or
failure of hepatitis B immunoglobulin therapy. Lamivudine resistance,
developing in approximately 25% after 12 months of therapy, is its main
limitation.
3. Famciclovir is safe in liver transplant recipients; however, virological
and clinical responses are less consistent than with lamivudine. Thus,
lamivudine is favored over famciclovir as first-line therapy in transplant
recipients with no previous exposure to nucleoside analogues.
4. Although limited in availability, adefovir dipivoxil appears safe and
effective in treating liver transplant recipients with lamivudine-resistant
HBV disease. Close monitoring of renal function is recommended, with dose
adjustment in patients with reduced creatinine clearances.
5. Limited data suggest that intravenous ganciclovir, tenofovir disoproxil
fumarate, and interferon alfa may be useful as rescue therapies for patients
with lamivudine- or famciclovir-resistant HBV disease.
6. Antiviral therapy with two or more suitable agents may minimize the
chance for viral resistance; therefore, future therapeutic strategies likely
will use combination therapy in the long-term management of recurrent HBV
disease. (Liver Transpl 2002;8:S74-S81.)

Publishing and Reprint Information TOP

From the University of California, San Francisco, CA.

Address reprint requests to Norah A. Terrault, MD, MPH, University of
California, Rm S357, 513 Pamarsus Ave, San Francisco, CA 64143-0538.
Telephone: 415-476-2227; FAX: 415-502-6714; E-mail: [email protected]

Copyright © 2002 by the American Association for the Study of Liver Diseases

1527-6465/02/0810-1005$35.00/0

doi:10.1053/jlts.2002.35784