Therapie der rekurrenten Hepatitis-B-Infektion nach Lebertransplantation - Eine retrospektive Analyse von 200 Lebertransplantationen aufgrund von Hepatitis-B-assoziierten Lebererkrankungen -

Abstract

Whereas it is generally accepted, that passive immunoprophylaxis lowers the reinfection rate it could be shown in the present study, that antiviral treatment lowers mortality of hepatitis B reinfection. The major problem of lamivudine and famciclovir is viral resistance formation. In this case an antiviral combination therapy might be useful, whereas retransplantation for hepatitis B reinfection should be considered carefully due to inferior graft survival rates.

Cost‐effective and safe ambulatory long‐term immunoprophylaxis with intramuscular instead of intravenous hepatitis B immunoglobulin to prevent reinfection after orthotopic liver transplantation

“…Earlier approach to induce passive immunoprophylaxis with hepatitis B immunoglobulin (HBIG) was one of the first attempts to prevent HBV reinfection (10, 11). As recurrent HBV still occurs in up to 44% of patients despite prophylaxis with HBIG (12, 13), recent studies suggested that therapeutic benefit might improve by combined treatment with HBIG and lamivudine (14–19).…”

Current management of hepatitis B virus infection before and after liver transplantation

“…Lamivudine has been used for cases with recurrence despite HBIG prophylaxis, but it will be inactive if there is lamivudine resistance (6). However, the progressively increasing rates of resistance to lamivudine, exceeding 50% at 3 years of therapy in transplant patients (105–109), make this strategy suboptimal. The emergence of such HBV mutants is often associated with the rapid development of advanced histological lesions and even liver failure and death in some HBV‐transplant patients (108, 110, 111).…”

Prevention of and Treatment for Hepatitis B Virus Infection After Liver Transplantation in the Nucleoside Analogues Era

“…Lamivudine has also given promising results for the treatment of patients with fibrosing cholestatic hepatitis (66,67). However, the progressively increasing rates of resistance to lamivudine, which were reported to be 27%, 40%, and > 50% at 1, 2, and 3 years of therapy (60,64, 68–70), may cause problems in the long‐term. Although the clinical significance of resistance to lamivudine is not clear in both transplant and nontransplant patients, and lamivudine‐resistant post‐transplant reinfection cases have been suggested to follow a relatively milder course than cases with wild HBV recurrence (71), the emergence of such HBV mutants has been associated with rapid development of advanced histologic lesions and even liver failure and death in some HBV transplant patients (69,72,73).…”

“…Besides lamivudine, several other nucleos(t)ide analogues have been tried or are currently evaluated for the treatment of subgroups of patients with HBV infection, including those with post‐transplant HBV recurrence. In the transplant setting, famciclovir, a guanosine analogue, has been tried (74), but it was found to be inferior to lamivudine (68,70,75). Ganciclovir, another guanosine analogue, was found to achieve reductions in both alanine aminotransferase (ALT) and serum HBV‐DNA levels as well as improvement of liver histology (76,77), but it is of limited use as long‐term therapy because of the low bioavailability of oral administration and the need for intravenous use.…”