Adefovir treatment for chronic hepatitis B in heart transplant recipients

Abstract: Chronic hepatitis B is prevalent in the transplant setting andmay cause significant complications. Effective control of viral replicationis needed. Besides lamivudine, very little data are available on safety andefficacy of other drugs. We describe our experience with adefovirdipivoxil (ADV) in eight heart transplant recipients. Studies included abaseline liver biopsy, thrice-monthly clinical, biochemical, and virologicalevaluations, including genotyping and viral load, polymerase genesequencing for resistance mutations, liver and kidney function tests, andliver ultrasound. Of eight patients, six had fibrosis score 2 and negativeHBeAg and seven had hepatitis B virus (HBV) genotype D. Upon ADVstart, median HBV-DNA was 5.8 logs IU/mL and alanineaminotransferase (ALT) levels were mostly normal. All patients hadprior mild-to-moderate renal functional impairment. Seven of eightpatients started ADV after a previous course of lamivudine. Five of theseseven patients became HBV-DNA undetectable within eight months.One patient with low baseline viremia started ADV de novo andsuppressed HBV-DNA. Median treatment duration was 66 months.ADV daily dose was halved in one patient due to renal functionworsening. No ALT flares, hypophosphatemia, liver decompensation,liver cancer, or emergence of resistance was observed. Our data suggestthat ADV may be a safe and effective rescue treatment for hearttransplant recipients with lamivudine-resistant chronic hepatitis B.Emanuele Durante-Mangoni