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Adefovir
Dipivoxil
as
Rescue
Therapy
for
Lamivudine-resistant
Hepatitis
B Post
Liver
Transplant
Complications
of
hepatitis
B virus
(HBV)
infection
are
among
the
most
common
indications
for
liver
transplant
in
many
parts
of
Asia.
However,
none
of
the
current
post
transplant
hepatitis
B prophylaxis
strategies,
namely,
lamivudine
(Epivir-HBV),
hepatitis
B immunoglobulin
(HBIG)
monotherapy,
or
combination
therapy,
is
ideal.
The
aim
of
this
study
was
to
evaluate
the
use
of
adefovir
dipivoxil/
ADV
(Hepsera)
as
a rescue
therapy
for
post
transplant
HBV
patients
who
developed
lamivudine
resistance.
Twenty-two
consecutive
patients
with
HBV-related
liver
disease,
who
underwent
first
liver
transplants
from
1995
to
2002,
received
HBV
prophylaxis
with
indefinite
lamivudine
with
substitution
of
ADV
for
patients
who
developed
drug
resistance
and
clinical
deterioration,
defined
as
persistent
elevation
of
transaminases
or
histologic
deterioration.
Results
Sixteen
patients
(73%)
were
alive
at
their
last
follow-up
and
six
(38%)
had
developed
hepatitis
B recurrence
at
a median
of
46
(range
9 to
74)
months
post
transplant.
Two
with
persistently
normal
transaminases
and
normal
liver
histology
at
3 and
42
months
post
recurrence
have
been
continued
on
lamivudine.
Four
showed
clinical
deterioration
and
received
ADV
for
a median
of
24
months;
all
displayed
normalization
of
transaminases
and
a 2
to
5 log
drop
in
HBV
DNA
titers.
Three
had
paired
biopsies
before
and
after
substitution
of
ADV
with
two
showing
improvement
and
one
stable
appearance.
The
median
serum
creatinine
value
increased
slightly
from
126
to
138
micromol/L
(P
= 0.72).
Conclusion The
authors
conclude,
“ADV
is
an
effective
rescue
therapy
for
patients
with
lamivudine-resistant
hepatitis
B post-liver
transplant.
Further
studies
are
needed
to
ascertain
the
optimal
post
transplant
hepatitis
B prophylaxis.” Singapore
Liver
Transplant
Program,
National
University
Hospital,
Singapore,
Singapore. 01/24/05 Reference
C
T Wai
and
others.
Adefovir
dipivoxil
as
the
rescue
therapy
for
lamivudine-resistant
hepatitis
B post
liver
transplant.
Transplant
Proceedings
36(8):
2313-2314.
October
2004.
Link
to
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to
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Hepatitis
B Articles
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to
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