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Article: Fibrosing cholestatic hepatitis secondary to precore/core promoter hepatitis B variant with lamivudine resistance: Successful retransplantation with combination adefovir dipivoxil and hepatitis B immunoglobulin

TitleFibrosing cholestatic hepatitis secondary to precore/core promoter hepatitis B variant with lamivudine resistance: Successful retransplantation with combination adefovir dipivoxil and hepatitis B immunoglobulin
Authors
Issue Date2004
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jtoc/106570021
Citation
Liver Transplantation, 2004, v. 10 n. 4, p. 557-563 How to Cite?
AbstractFibrosing cholestatic hepatitis (FCH) is a peculiar variant of hepatitis B virus (HBV) infection in immunocompromised patients characterized by rapid viral replication. Posttransplant patients receiving lamivudine for prophylaxis or treatment of HBV infection may develop drug resistance due to viral mutants, but FCH is rare because escape mutants are usually replication deficient. We report the development of FCH due to lamivudine-resistant HBV mutants in 2 patients at 12 and 13 months after liver transplantation. Rapidly progressive graft failure, accompanied by an escalating HBV DNA level, developed within weeks of onset. Analysis of gene sequence variation by polymerase chain reaction (PCR) and direct sequencing showed that both had a core promoter variant A1762T/G1764A and 1 had a concomitant precore stop codon G1896A variant in prelamivudine and postrecurrence serum samples. Comparison of the HBV polymerase gene in the 2 serum samples revealed a single mutation with methionine-to-isoleucine substitution at codon 552 (M552I) in both patients. "Add-in" treatment with adefovir dipivoxil resulted in a more than 2 to 3 log10 reduction in HBV DNA level within 2 weeks and retransplantation was performed with adefovir dipivoxil and hepatitis B immunoglobulin (HBIG) prophylaxis. Both patients were alive at 15 months and 48 months after retransplantation, with normal graft function and serum negative for HBsAg and HBV DNA by quantitative PCR (< 200 copies/mL). The current report demonstrates that recurrent graft infection by precore/core promoter variant with lamivudine-resistant escape mutation may result in FCH. With combination of adefovir and high-dose HBIG, however, long-term survival can be achieved after retransplantation. Copyright © 2004 by the American Association for the Study of Liver Diseases.
Persistent Identifierhttp://hdl.handle.net/10722/76423
ISSN
2015 Impact Factor: 3.951
2015 SCImago Journal Rankings: 1.763
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLo, CMen_HK
dc.contributor.authorCheung, STen_HK
dc.contributor.authorNg, IOLen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorLai, CLen_HK
dc.contributor.authorFan, STen_HK
dc.date.accessioned2010-09-06T07:21:05Z-
dc.date.available2010-09-06T07:21:05Z-
dc.date.issued2004en_HK
dc.identifier.citationLiver Transplantation, 2004, v. 10 n. 4, p. 557-563en_HK
dc.identifier.issn1527-6465en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76423-
dc.description.abstractFibrosing cholestatic hepatitis (FCH) is a peculiar variant of hepatitis B virus (HBV) infection in immunocompromised patients characterized by rapid viral replication. Posttransplant patients receiving lamivudine for prophylaxis or treatment of HBV infection may develop drug resistance due to viral mutants, but FCH is rare because escape mutants are usually replication deficient. We report the development of FCH due to lamivudine-resistant HBV mutants in 2 patients at 12 and 13 months after liver transplantation. Rapidly progressive graft failure, accompanied by an escalating HBV DNA level, developed within weeks of onset. Analysis of gene sequence variation by polymerase chain reaction (PCR) and direct sequencing showed that both had a core promoter variant A1762T/G1764A and 1 had a concomitant precore stop codon G1896A variant in prelamivudine and postrecurrence serum samples. Comparison of the HBV polymerase gene in the 2 serum samples revealed a single mutation with methionine-to-isoleucine substitution at codon 552 (M552I) in both patients. "Add-in" treatment with adefovir dipivoxil resulted in a more than 2 to 3 log10 reduction in HBV DNA level within 2 weeks and retransplantation was performed with adefovir dipivoxil and hepatitis B immunoglobulin (HBIG) prophylaxis. Both patients were alive at 15 months and 48 months after retransplantation, with normal graft function and serum negative for HBsAg and HBV DNA by quantitative PCR (< 200 copies/mL). The current report demonstrates that recurrent graft infection by precore/core promoter variant with lamivudine-resistant escape mutation may result in FCH. With combination of adefovir and high-dose HBIG, however, long-term survival can be achieved after retransplantation. Copyright © 2004 by the American Association for the Study of Liver Diseases.en_HK
dc.languageengen_HK
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jtoc/106570021en_HK
dc.relation.ispartofLiver Transplantationen_HK
dc.rightsLiver Transplantation. Copyright © John Wiley & Sons, Inc.en_HK
dc.subject.meshAdenine - analogs & derivatives - therapeutic useen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAntiviral Agents - therapeutic useen_HK
dc.subject.meshCholestasis, Intrahepatic - drug therapy - etiology - surgeryen_HK
dc.subject.meshDrug Resistance, Viral - geneticsen_HK
dc.subject.meshDrug Therapy, Combinationen_HK
dc.subject.meshHepatitis B - complications - drug therapy - surgeryen_HK
dc.subject.meshHepatitis B Core Antigens - geneticsen_HK
dc.subject.meshHumansen_HK
dc.subject.meshImmunoglobulins - therapeutic useen_HK
dc.subject.meshLamivudine - therapeutic useen_HK
dc.subject.meshLiver Cirrhosis - drug therapy - etiology - surgeryen_HK
dc.subject.meshLiver Transplantationen_HK
dc.subject.meshMaleen_HK
dc.subject.meshPhosphonic Acidsen_HK
dc.subject.meshPromoter Regions, Genetic - geneticsen_HK
dc.subject.meshReoperationen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleFibrosing cholestatic hepatitis secondary to precore/core promoter hepatitis B variant with lamivudine resistance: Successful retransplantation with combination adefovir dipivoxil and hepatitis B immunoglobulinen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1527-6465&volume=10&issue=4&spage=557&epage=563&date=2004&atitle=Fibrosing+cholestatic+hepatitis+secondary+to+precore/core+promoter+hepatitis+B+variant+with+lamivudine+resistance:+successful+retransplantation+with+combination+adefovir+dipivoxil+and+hepatitis+B+immunoglobulinen_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailCheung, ST: stcheung@hkucc.hku.hken_HK
dc.identifier.emailNg, IOL: iolng@hkucc.hku.hken_HK
dc.identifier.emailLai, CL: hrmelcl@hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityCheung, ST=rp00457en_HK
dc.identifier.authorityNg, IOL=rp00335en_HK
dc.identifier.authorityLai, CL=rp00314en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1002/lt.20133en_HK
dc.identifier.pmid15048802-
dc.identifier.scopuseid_2-s2.0-1842477048en_HK
dc.identifier.hkuros86106en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-1842477048&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume10en_HK
dc.identifier.issue4en_HK
dc.identifier.spage557en_HK
dc.identifier.epage563en_HK
dc.identifier.isiWOS:000220434900015-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridCheung, ST=7202473497en_HK
dc.identifier.scopusauthoridNg, IOL=7102753722en_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridLai, CL=7403086396en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK

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