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Titolo:
Occurrence and clinical outcome of lamivudine-resistant hepatitis B infection after liver transplantation
Autore:
Seehofer, D; Rayes, N; Steinmuller, T; Muller, AR; Settmacher, U; Neuhaus, R; Radke, C; Berg, T; Hopf, U; Neuhaus, P;
Indirizzi:
Humboldt Univ, Dept Gen Visceral & Transplant Surg, D-13353 Berlin, Germany Humboldt Univ Berlin Germany D-13353 plant Surg, D-13353 Berlin, Germany Humboldt Univ, Dept Gastroenterol, D-13353 Berlin, Germany Humboldt Univ Berlin Germany D-13353 troenterol, D-13353 Berlin, Germany Humboldt Univ, Dept Pathol, D-13353 Berlin, Germany Humboldt Univ BerlinGermany D-13353 ept Pathol, D-13353 Berlin, Germany
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 11, volume: 7, anno: 2001,
pagine: 976 - 982
SICI:
1527-6465(200111)7:11<976:OACOOL>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
VIRUS-INFECTION; IMMUNE GLOBULIN; THERAPY; RECURRENCE; PROPHYLAXIS; FAMCICLOVIR; MUTATIONS; EFFICACY; MUTANTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
22
Recensione:
Indirizzi per estratti:
Indirizzo: Seehofer, D Humboldt Univ, Dept Gen Visceral & Transplant Surg, Charite Campus Virchow,Augustenburger Pl 1, D-13353 Berlin, Germany Humboldt Univ Charite Campus Virchow,Augustenburger Pl 1 Berlin Germany D-13353
Citazione:
D. Seehofer et al., "Occurrence and clinical outcome of lamivudine-resistant hepatitis B infection after liver transplantation", LIVER TRANS, 7(11), 2001, pp. 976-982

Abstract

Lamivudine treatment of hepatitis B after orthotopic liver transplantation(OLT) is often accompanied by fast viral-resistance formation. Although noclinical data are available, in vitro data indicate that lamivudine-resistant reinfection has a mild course because of defective viral replication. Between 1996 and 1999, a total of 34 patients were treated with lamivudine because of hepatitis B recurrence after OLT. All patients developed reinfection despite long-term passive immunoprophylaxis with hepatitis B immunoglobulin, diagnosed by positive hepatitis B surface antigen and positive hepatitis B virus (HBV) DNA. Before treatment with lamivudine, 21 of these patients underwent a course of famciclovir and developed resistance. Monthly laboratory tests and sequential liver biopsies were performed during the follow-up period. Nineteen of 34 patients (56%) developed lamivudine resistance during the follow-up period of 12 to 49 months. One- and 3-year graft survival rates after the diagnosis of lamivudine resistance were 89% and 66%, respectively. In most cases, lamivudine resistance was associated with high viral replication (3,012 +/- 574 pg/mL 1 month after the diagnosis of lamivudine resistance); however, liver enzyme levels were only moderately elevated(alanine aminotransferase [ALT], 45 +/- 16 U/L). Only 3 patients (15%) showed a rapid increase in ALT level to more than 500 U/L within 3 months after resistance developed. All other patients had mildly elevated liver enzymelevels during the first 6 to 8 months after lamivudine resistance. In the later course, liver enzyme levels increased in most patients. Fourteen patients with elevated transaminase levels were switched to lamivudine plus interferon alfa (n = 8) or lamivudine plus famciclovir therapy (n = 6). This combination was successful in most cases, decreasing HBV DNA and liver enzyme levels. Four patients with lamivudine resistance died during follow-up, only 1 patient because of HBV reinfection. In addition, 2 patients underwentretransplantation because of hepatitis B cirrhosis of the first graft. Compared with historic courses of wild-type recurrence, lamivudine-resistant reinfection is characterized by a milder clinical course. Fulminant cases were not observed; however, in three cases, chronic liver failure developed. The combination of different antivirals diminished viral replication after lamivudine resistance. In the future, new antiviral agents, such as adefovir, might further expand therapeutic options.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/01/20 alle ore 07:24:40