Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-up
Lamivudine is a nucleoside analogue with efficacy in the suppression of hepatitis B viral (HBV) replication. In a previously reported study, lamivudine was administered to patients with chronic, actively replicating HBV infection who subsequently underwent liver transplantation. Patients became seru...
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doaj-dea9f93269d54174a06f9152f28898d72020-11-24T22:49:05ZengHindawi LimitedCanadian Journal of Gastroenterology0835-79001998-01-0112212512910.1155/1998/617039Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-upEric M Yoshida0Mang M Ma1Jennifer E Davis2Karl P Fischer3Norman M Kneteman4Siegfried R Erb5D Lorne Tyrrell6Vincent G Bain7Department of Medicine, University of British Columbia, CanadaDepartment of Medicine, University of Alberta, Edmonton, Alberta, CanadaDepartment of Medicine, University of British Columbia, CanadaDepartment of Medicine, University of Alberta, Edmonton, Alberta, CanadaDepartment of Surgery, University of Alberta, Edmonton, Alberta, CanadaDepartment of Medicine, University of British Columbia, CanadaDepartment of Medicine, University of British Columbia, CanadaDepartment of Medicine, University of Alberta, Edmonton, Alberta, CanadaLamivudine is a nucleoside analogue with efficacy in the suppression of hepatitis B viral (HBV) replication. In a previously reported study, lamivudine was administered to patients with chronic, actively replicating HBV infection who subsequently underwent liver transplantation. Patients became serum HBV DNA-negative in response to lamivudine before transplantation, which was continued in the post-transplant period. Two of four patients surviving the immediate postoperative period developed allograft reinfection 240 and 409 days post-transplant. The strain of the reinfecting virus was analyzed, and a mutation in the YMDD region of the viral polymerase conferring resistance to lamivudine was discovered. The long term follow-up of these two patients is reported. The first patient developed ascites 16.5 months after allograft reinfection. A transjugular liver biopsy performed 18 months after the emergence of the lamivudine-resistant strain revealed cirrhosis and lobular hepatitis without rejection. The gradient between hepatic vein wedged and free pressures was 13 mmHg, consistent with portal hypertension. The second patient, 16 months after allograft reinfection with the lamivudine-resistant strain, is without clinical evidence of portal hypertension, although liver enzymes remain elevated. Both patients were given a trial of famciclovir, which did not significantly suppress HBV viremia. In conclusion, lamivudine-resistant HBV strains with the YMDD mutation may have an aggressive clinical course with rapid progression to cirrhosis. Famciclovir did not appear to be an effective rescue agent in these two patients.http://dx.doi.org/10.1155/1998/617039 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eric M Yoshida Mang M Ma Jennifer E Davis Karl P Fischer Norman M Kneteman Siegfried R Erb D Lorne Tyrrell Vincent G Bain |
spellingShingle |
Eric M Yoshida Mang M Ma Jennifer E Davis Karl P Fischer Norman M Kneteman Siegfried R Erb D Lorne Tyrrell Vincent G Bain Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-up Canadian Journal of Gastroenterology |
author_facet |
Eric M Yoshida Mang M Ma Jennifer E Davis Karl P Fischer Norman M Kneteman Siegfried R Erb D Lorne Tyrrell Vincent G Bain |
author_sort |
Eric M Yoshida |
title |
Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-up |
title_short |
Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-up |
title_full |
Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-up |
title_fullStr |
Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-up |
title_full_unstemmed |
Postliver Transplant Allograft Reinfection with a Lamivudine-Resistant Strain of Hepatitis B Virus: Long Term Follow-up |
title_sort |
postliver transplant allograft reinfection with a lamivudine-resistant strain of hepatitis b virus: long term follow-up |
publisher |
Hindawi Limited |
series |
Canadian Journal of Gastroenterology |
issn |
0835-7900 |
publishDate |
1998-01-01 |
description |
Lamivudine is a nucleoside analogue with efficacy in the suppression of hepatitis B viral (HBV) replication. In a previously reported study, lamivudine was administered to patients with chronic, actively replicating HBV infection who subsequently underwent liver transplantation. Patients became serum HBV DNA-negative in response to lamivudine before transplantation, which was continued in the post-transplant period. Two of four patients surviving the immediate postoperative period developed allograft reinfection 240 and 409 days post-transplant. The strain of the reinfecting virus was analyzed, and a mutation in the YMDD region of the viral polymerase conferring resistance to lamivudine was discovered. The long term follow-up of these two patients is reported. The first patient developed ascites 16.5 months after allograft reinfection. A transjugular liver biopsy performed 18 months after the emergence of the lamivudine-resistant strain revealed cirrhosis and lobular hepatitis without rejection. The gradient between hepatic vein wedged and free pressures was 13 mmHg, consistent with portal hypertension. The second patient, 16 months after allograft reinfection with the lamivudine-resistant strain, is without clinical evidence of portal hypertension, although liver enzymes remain elevated. Both patients were given a trial of famciclovir, which did not significantly suppress HBV viremia. In conclusion, lamivudine-resistant HBV strains with the YMDD mutation may have an aggressive clinical course with rapid progression to cirrhosis. Famciclovir did not appear to be an effective rescue agent in these two patients. |
url |
http://dx.doi.org/10.1155/1998/617039 |
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