Favourable outcome of adefovir-dipivoxil treatment in acute de novo hepatitis B after liver transplantation1

Abstract

Adefovir-dipivoxil has been shown to be effective against lamivudine-resistant mutants in immunocompetent patients and in a small number of liver transplant recipients with recurrent hepatitis B virus (HBV) infection. The therapeutic role of adefovir-dipivoxil in acute de novo HBV infection after transplantation is uncertain. We describe a case of acute de novo HBV infection that occurred after liver transplantation and that was treated with lamivudine followed (when viral escape mutants emerged) by adefovir-dipivoxil rescue. Treatment outcome was excellent, with complete viral clearance and development of a protective titer of antibodies to anti-hepatitis B surface antigen. Because the donor was vaccinated against HBV, it is conceivable that clearance of HBV infection in the recipient might have been favored by adoptive transfer of immunity to HBV. The immune status of the donor might be a factor to consider when determining the treatment options for de novo hepatitis B.

Liver Transplantation Using Hepatitis B Core Antibody−Positive Grafts: Review and University of Tokyo Experience

“…Resistance to adefovir dipivoxil is less common than for lamivudine [43]. Adefovir dipivoxil shows favorable outcome in patients with de novo hepatitis B after liver transplantation [44] and in the patients with lamivudineresistant hepatitis B [45,46]. Recently, alternative nucleoside analogs adefovir dipivoxil, entecavir [47], telbivudine [48], and tenofovir [49] were administered efficiently in treating wild-type and/or mutated HBV.…”

Can Donors With Prior Hepatitis Be Safely Used for Heart Transplantation?

“…30 Adefovir has been used in lamivudine-resistant HBV infection in liver transplantation and has shown a positive effect. 31,32 Many transplant programs use prophylactic or preemptive treatment for cytomegalovirus (CMV) that includes early ganciclovir or valganciclovir dosing, sometimes followed by acyclovir. 32,33 (since 3-month courses have become more popular, the acyclovir "tail" has been used less frequently at some centers).…”

Liver transplantation for hepatitis B-related cirrhosis: recent advances

“…In a Hong Kong series of patients receiving LAM mono‐therapy, the low recurrence rate (4%) may have been due to the transplantation of passenger leukocytes in HBV‐immune donors that produced HBsAb in the recipients, although this hypothesis remains to be tested . A recent report ascribed the successful elimination of a de‐novo HBV infection post‐DDLT, with the development of HBsAb, to the fact that the liver donor had been immunized against HBV …”