Adefovir (Hepsera) Prevents Post-transplant HBV Recurrence as well as HBIG

Liver transplantation is the only treatment for end-stage liver failure due to chronic hepatitis B virus (HBV) infection, but without preventive therapy, the virus typically quickly attacks the new liver, which can lead to complications, organ failure, and death.

The usual post-transplant prophylactic regimen consists of a combination of injected hepatitis B immunoglobulin (HBIG) plus the oral antiviral drug lamivudine (Epivir-HBV), which reduces the rate of HBV recurrence to less than 5% at 5 years, but HBIG administration is inconvenient and costly.

As described in the November 2008 issue of Hepatology, Peter Angus of the Victorian Liver Transplant Unit in Victoria, Australia, and colleagues evaluated substitution of adefovir (Hepsera) instead of low-dose intramuscular HBIG in patients without HBV recurrence at least 12 months after liver transplantation due to HBV-related disease.

The multicenter trial included 34 liver transplant recipients, 16 of whom were randomly assigned to receive adefovir (1 patient withdrew consent at 3 months and is not included in the results) and 18 of whom continued using HBIG. All participants also continued lamivudine.

The 2 groups were well matched according to sex, age, time since transplantation (median 4.5 years), and virological risk for HBV recurrence (30% in the adefovir group and 24% in the HBIG group with detectable HBV DNA at the time of transplantation).

The researchers assessed HBV recurrence and monitored levels of creatinine, a biomarker of kidney dysfunction, since kidney toxicity is a potential side effect of adefovir.

Results

Based on these findings, the study authors concluded, "Compared with combination HBIG plus lamivudine prophylaxis, combination adefovir plus lamivudine provides equivalent protection against recurrent HBV infection but with better tolerability and less cost."

Victorian Liver Transplant Unit, Austin Health, Victoria, Australia; AW Morrow Gastroenterology and Liver Center and Centenary Research Institute, Australian Liver Transplant Unit, Royal Prince Alfred Hospital, University of Sydney, New South Wales, Australia; New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.

1/27/09

Reference

PW Angus, SJ Patterson, SI Strasser, and others. A randomized study of adefovir dipivoxil in place of HBIG in combination with lamivudine as post-liver transplantation hepatitis B prophylaxis. Hepatology 48(5): 1460-1466. November 2008. (Abstract).