Favorable outcome of liver transplantation despite a high hepatitis B virus replication: beyond the limits?

Abstract

Patients with end-stage liver disease due to chronic hepatitis B virus (HBV) infection with a persistent viral replication are generally denied liver transplantation (LT). We report the case of a patient who presented with the emergence of a YMDD escape mutant virus under lamivudine treatment, and developed terminal liver failure requiring LT. Pre-LT introduction of adefovir led to only a mild decrease in replication. The patient was treated with a combination of intravenous hepatitis B immune globulin (HBIG) that was started perioperatively, and also continued lamivudine and adefovir after LT. One year after LT, there was no evidence of HBV infection recurrence. This observation suggests that persistent high HBV replication might not be a contra-indication to LT, providing adequate and effective prophylaxis is given, using HBIG and antiviral drug combination therapy.

Pharmacokinetics of tacrolimus co‐administered with adefovir dipivoxil to liver transplant recipients

“…Our results provide the in vivo evidence to support these in vitro findings, as we found no significant pharmacological interaction between adefovir and tacrolimus after 14 days of co-administration. Our results are also consistent with the reported positive clinical experience of adefovir in transplant recipients (3,(6)(7)(8).…”

Hepatitis B Immunoglobulin and Lamivudine Improve Hepatitis B–Related Outcomes After Liver Transplantation: Meta-Analysis

“…The use of HBIG and LAM in post-liver transplant treatment regimens revolutionized the posttransplantation management of HBV and greatly improved HBV-related morbidity after transplantation. 8 HBIG and LAM are both considered to be safe and effective agents for the treatment of chronic hepatitis B in the post-liver transplant setting. 8 HBIG is a plasma product that is rich in immunoglobulins that can prevent HBV if given within 14 days of exposure to an HBVinfected individual and is effective in 85%-90% of cases when it is used as a post-exposure prophylaxis.…”

“…8 HBIG and LAM are both considered to be safe and effective agents for the treatment of chronic hepatitis B in the post-liver transplant setting. 8 HBIG is a plasma product that is rich in immunoglobulins that can prevent HBV if given within 14 days of exposure to an HBVinfected individual and is effective in 85%-90% of cases when it is used as a post-exposure prophylaxis. These beneficial effects of HBIG were also used in the post-liver transplant setting to minimize the risk of HBV recurrence.…”