Document Detail

Combination therapy in liver transplant recipients with hepatitis B virus without hepatitis B immune globulin.
MedLine Citation:
PMID:  17404847     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Conventional therapy to prevent HBV recurrence in liver transplant (LTx) recipients consists of Hepatitis B Immune Globulin (HBIg). The aim of this review is to investigate the safety and efficacy of converting HBIg and LAM therapy to ADV and LAM therapy.
METHODS: A retrospective review involving all liver transplant patients with HBV maintained on HBIg and LAM therapy. Results collected included: gender, age, HBV serological and DNA status (COBAS AmpliScreen PCR-based testing). Serologic testing was done every three months. Patients were followed for drug reactions, therapy compliance, and immune suppression compliance. A cost benefit analysis was done for drug comparisons using United States currency values.
RESULTS: Patient demographics included: Male (n=6), Female (n=4), mean age 44 years (range 33 to 65). The mean length of follow up since therapy conversion (from HBIg and LMV to ADV and LMV) was 21 months (range 16 to 25 months). Serological status at time of conversion revealed that DNA status remained negative in all patients, HBsAg negative in 10/10, HB eAg (+) (5/10) and HBeAb (+)(5/10). None of the patients experienced an increase in transaminases while on dual ADV and LAM therapy. All patients were maintained on immune suppression monotherapy (tacrolimus) at 7-9 ng/mL. All patients reported compliance with the dual therapy and that they experienced no drug related side effects. Mean yearly costs for ADV and LAM was 7,235.00 United States dollars (range 6,550.00 to 8,225.00); while mean monthly costs for HBIg and LAM; 9225.00 (range 7205.00 to 12005.00).
CONCLUSION: The above results demonstrate beneficial effects of ADV and LAM in place of the current standard of HBIg and LAM therapy. Safety and short term results show nucleoside therapy is adequate at preventing HBV viral recurrence. Lastly, the economic benefit for ADV and LAM vastly outweighed the HBIg and LAM group.
Guy W Neff; Nyingi Kemmer; Tiffany E Kaiser; Victoria C Zacharias; Michele Alonzo; Mark Thomas; Joseph Buell
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Publication Detail:
Type:  Journal Article     Date:  2007-04-03
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  52     ISSN:  0163-2116     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-06     Completed Date:  2007-10-25     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2497-500     Citation Subset:  AIM; IM    
Department of Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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MeSH Terms
Adenine / analogs & derivatives*,  therapeutic use
Antibodies, Viral / analysis
Antiviral Agents / therapeutic use
DNA, Viral / analysis
Drug Therapy, Combination
Follow-Up Studies
Hepatitis B / drug therapy*,  virology
Hepatitis B e Antigens / analysis
Hepatitis B virus / genetics,  immunology*
Immunization, Passive
Immunoglobulins / therapeutic use*
Immunosuppressive Agents
Lamivudine / therapeutic use*
Liver Transplantation*
Middle Aged
Organophosphonates / therapeutic use*
Recurrence / prevention & control
Retrospective Studies
Reverse Transcriptase Inhibitors / therapeutic use
Treatment Outcome
Reg. No./Substance:
0/Antibodies, Viral; 0/Antiviral Agents; 0/DNA, Viral; 0/Hepatitis B e Antigens; 0/Immunoglobulins; 0/Immunosuppressive Agents; 0/Organophosphonates; 0/Reverse Transcriptase Inhibitors; 0/hepatitis B hyperimmune globulin; 134678-17-4/Lamivudine; 6GQP90I798/adefovir; 73-24-5/Adenine

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