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Conference Paper: Liver transplantation for chronic hepatitis B with lamivudine-resistant YMDD mutant using add-on adefovir dipivoxil to lamivudine

TitleLiver transplantation for chronic hepatitis B with lamivudine-resistant YMDD mutant using add-on adefovir dipivoxil to lamivudine
Authors
Issue Date2005
PublisherBlackwell Munksgaard. The Journal's web site is located at http://www.blackwellpublishing.com/journals/AJT
Citation
The American Transplant Congress, Seattle, WA., 21-25 May 2005. In American Journal of Transplantation, 2005, v. 5 suppl 11, p. 180 abstract no. 95 How to Cite?
AbstractLamivudine treatment for patients with chronic hepatitis B virus (HBV) infection may improve clinical state and suppress viral replication before liver transplantation (LTx). Emergence of lamivudine-resistant YMDD mutant is common and may be regarded as a contraindication for transplantation. We report the results of LTx in 16 patients with pre-transplant YMDD mutants after receiving lamivudine for a median of 738 days (400 to 1799 days). Adefovir dipivoxil (10 mg daily) was added-on to lamivudine for a median duration of 20 (8 to 271) days before (n=11) or at (n=5) LTx and the combination was continued indefinitely thereafter. Eight patients received additional intravenous hepatitis B immune globulin (HBIG) for a median of 24 months. Fifteen patients with known pre-adefovir serum HBVDNA level had a median titer of 14,200 x 103 (2.2 x 103 to 4,690,000 x 103) copies/ml and 14 had HBVDNA >105 copies/ml. All except one patient remained positive for HBVDNA (by qPCR) at the time of LTx and the titer was >105 copies/ml in 8 patients. The median follow-up after LTx was 21.1 (4.4 to 68.9) months. One patient died of an unrelated cause at 12.2 months post-transplant and 15 (94%) patients were alive with the original graft. All patients cleared HBVDNA and had no detectable HBVDNA by qPCR at the latest follow-up. Fourteen patients had HBsAg seroconversion but 2 patients who received only adefovir dipivoxil and lamivudine without HBIG had not cleared HBsAg after 7.7 and 9.5 months. Serum HBVDNA, however was negative and there was no biochemical or histologic evidence of recurrence. Adefovir dipivoxil was well-tolerated with no significant renal toxicity. In conclusion, combination of add-on adefovir dipivoxil to lamivudine therapy provides effective prophylaxis in patients with pre-transplant YMDD mutant that may be actively replicating. The cost effectiveness of additional passive immunoprophylaxis remains to be defined.
Persistent Identifierhttp://hdl.handle.net/10722/88428
ISSN
2015 Impact Factor: 5.669
2015 SCImago Journal Rankings: 2.792

 

DC FieldValueLanguage
dc.contributor.authorLo, CMen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorLau, Gen_HK
dc.contributor.authorChan, SCen_HK
dc.contributor.authorNg, IOLen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T09:43:14Z-
dc.date.available2010-09-06T09:43:14Z-
dc.date.issued2005en_HK
dc.identifier.citationThe American Transplant Congress, Seattle, WA., 21-25 May 2005. In American Journal of Transplantation, 2005, v. 5 suppl 11, p. 180 abstract no. 95en_HK
dc.identifier.issn1600-6135en_HK
dc.identifier.urihttp://hdl.handle.net/10722/88428-
dc.description.abstractLamivudine treatment for patients with chronic hepatitis B virus (HBV) infection may improve clinical state and suppress viral replication before liver transplantation (LTx). Emergence of lamivudine-resistant YMDD mutant is common and may be regarded as a contraindication for transplantation. We report the results of LTx in 16 patients with pre-transplant YMDD mutants after receiving lamivudine for a median of 738 days (400 to 1799 days). Adefovir dipivoxil (10 mg daily) was added-on to lamivudine for a median duration of 20 (8 to 271) days before (n=11) or at (n=5) LTx and the combination was continued indefinitely thereafter. Eight patients received additional intravenous hepatitis B immune globulin (HBIG) for a median of 24 months. Fifteen patients with known pre-adefovir serum HBVDNA level had a median titer of 14,200 x 103 (2.2 x 103 to 4,690,000 x 103) copies/ml and 14 had HBVDNA >105 copies/ml. All except one patient remained positive for HBVDNA (by qPCR) at the time of LTx and the titer was >105 copies/ml in 8 patients. The median follow-up after LTx was 21.1 (4.4 to 68.9) months. One patient died of an unrelated cause at 12.2 months post-transplant and 15 (94%) patients were alive with the original graft. All patients cleared HBVDNA and had no detectable HBVDNA by qPCR at the latest follow-up. Fourteen patients had HBsAg seroconversion but 2 patients who received only adefovir dipivoxil and lamivudine without HBIG had not cleared HBsAg after 7.7 and 9.5 months. Serum HBVDNA, however was negative and there was no biochemical or histologic evidence of recurrence. Adefovir dipivoxil was well-tolerated with no significant renal toxicity. In conclusion, combination of add-on adefovir dipivoxil to lamivudine therapy provides effective prophylaxis in patients with pre-transplant YMDD mutant that may be actively replicating. The cost effectiveness of additional passive immunoprophylaxis remains to be defined.-
dc.languageengen_HK
dc.publisherBlackwell Munksgaard. The Journal's web site is located at http://www.blackwellpublishing.com/journals/AJTen_HK
dc.relation.ispartofAmerican Journal of Transplantationen_HK
dc.rightsThe definitive version is available at www.blackwell-synergy.com-
dc.titleLiver transplantation for chronic hepatitis B with lamivudine-resistant YMDD mutant using add-on adefovir dipivoxil to lamivudineen_HK
dc.typeConference_Paperen_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailLiu, CL: clliu@hkucc.hku.hken_HK
dc.identifier.emailLau, G: gkklau@netvigator.comen_HK
dc.identifier.emailChan, SC: chanlsc@hku.hken_HK
dc.identifier.emailNg, IOL: iolng@hkucc.hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hk-
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityChan, SC=rp01568en_HK
dc.identifier.authorityNg, IOL=rp00335en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.doi10.1111/j.1600-6135.2005.abstracts.x-
dc.identifier.hkuros99910en_HK
dc.identifier.hkuros99909-
dc.identifier.volume5-
dc.identifier.issuesuppl 11-
dc.identifier.spage180-
dc.identifier.epage180-

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