Efficacy of combined lamivudine and adefovir dipivoxil treatment for severe HBV graft reinfection after living donor liver transplantation

Susanne Beckebaum, Massimo Malagó, Olaf Dirsch, Vito R. Cicinnati, Martin Trippler, Pietro Lampertico, Nicole Lama, Ulrich Treichel, Guido Gerken, Christoph E. Broelsch

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Resistance to lamivudine and hyperimmune globulin (HBIG) may cause severe graft reinfection with progression to fulminant hepatic failure in liver transplant recipients. In this report, we describe the clinical course of a patient with perinatally acquired chronic hepatitis B virus (HBV) infection and hepatocellular carcinoma who developed severe fibrosing cholestatic hepatitis after living donor liver transplantation because of the emergence of lamivudine and HBIG-resistant chronic hepatitis B. Immunohistochemistry demonstrated that more than 30% of hepatocytes stained positively for hepatitis B core antigen. Hepatitis B virus sequence analysis revealed several mutations in the polymerase gene (L528M, M5521, M552V) as well as in the surface gene region encoding the immunogenic major hydrophilic loop of the small surface protein (G130N, M133T, D144G). The amino acid exchange at codon 144 has already been described to escape neutralization by HBIG. Combined treatment with lamivudine and adefovir dipivoxil (ADV) was associated with a dramatic biochemical, virological and clinical response with resolution of jaundice, ascites, peripheral edema and pleural effusions. Serum bilirubin normalized, HBV DNA levels significantly decreased and liver biopsy was remarkable for the absence of viral protein. These results indicate that ADV may provide a sustained rescue treatment for aggressive courses of HBV graft reinfection in liver transplant recipients.

Original languageEnglish
Pages (from-to)554-559
Number of pages6
JournalClinical Transplantation
Volume17
Issue number6
DOIs
Publication statusPublished - Dec 2003

Fingerprint

Lamivudine
Living Donors
Hepatitis B virus
Liver Transplantation
Transplants
Chronic Hepatitis B
Liver
Hepatitis B Core Antigens
Acute Liver Failure
Globulins
Viral Proteins
Virus Diseases
Pleural Effusion
Therapeutics
Jaundice
Bilirubin
Ascites
Codon
Hepatitis
Genes

Keywords

  • Adefovir dipivoxil
  • Fibrosing cholestatic hepatitis
  • Graft reinfection
  • Hepatitis B virus
  • Hyperimmune globulin
  • Lamivudine
  • Lamivudine resistance
  • Liver transplantation
  • Nucleoside analogues

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Efficacy of combined lamivudine and adefovir dipivoxil treatment for severe HBV graft reinfection after living donor liver transplantation. / Beckebaum, Susanne; Malagó, Massimo; Dirsch, Olaf; Cicinnati, Vito R.; Trippler, Martin; Lampertico, Pietro; Lama, Nicole; Treichel, Ulrich; Gerken, Guido; Broelsch, Christoph E.

In: Clinical Transplantation, Vol. 17, No. 6, 12.2003, p. 554-559.

Research output: Contribution to journalArticle

Beckebaum, S, Malagó, M, Dirsch, O, Cicinnati, VR, Trippler, M, Lampertico, P, Lama, N, Treichel, U, Gerken, G & Broelsch, CE 2003, 'Efficacy of combined lamivudine and adefovir dipivoxil treatment for severe HBV graft reinfection after living donor liver transplantation', Clinical Transplantation, vol. 17, no. 6, pp. 554-559. https://doi.org/10.1046/j.0902-0063.2003.00097.x
Beckebaum, Susanne ; Malagó, Massimo ; Dirsch, Olaf ; Cicinnati, Vito R. ; Trippler, Martin ; Lampertico, Pietro ; Lama, Nicole ; Treichel, Ulrich ; Gerken, Guido ; Broelsch, Christoph E. / Efficacy of combined lamivudine and adefovir dipivoxil treatment for severe HBV graft reinfection after living donor liver transplantation. In: Clinical Transplantation. 2003 ; Vol. 17, No. 6. pp. 554-559.
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