Retransplantation for precore mutant-related chronic hepatitis B infection: prolonged survival in a patient receiving sequential ganciclovir/famciclovir therapy.

Retransplantation for hepatitis B-related liver allograft failure is rarely successful. Recurrence of infection is almost universal, and the second allograft is invariably lost more rapidly than the first. In a recent multicenter study, only 1 of 20 hepatitis B virus (HBV)-positive patients who underwent liver retransplantation survived beyond 6 months. This report describes the long-term effect of antiviral therapy in a 56-year-old man who was retransplanted for HBV-related allograft loss 14 months after his initial liver transplant. He was treated after the second transplant with intravenous daily ganciclovir. After 10 months of this therapy HBV recurrence was detected. After a change to oral famciclovir therapy, there was a decrease in serum HBV DNA and amino-transferase levels and an improvement in the patient's clinical condition. Famiciclovir therapy has now been continued for 26 months, and the patient remains well 3 years after his second transplant, despite persistent HBV infection and progression to cirrhosis. These observations indicate that the use of long-term antiviral therapy offers promise for improving outcomes in patients who undergo retransplantation after HBV-related liver allograft failure.

[1]  E. Keeffe,et al.  Ganciclovir treatment of hepatitis B virus infection in liver transplant recipients , 1996, Hepatology.

[2]  P. Angus,et al.  Hepatitis B virus precore mutant infection is associated with severe recurrent disease after liver transplantation , 1995, Hepatology.

[3]  C. Scudamore,et al.  Attempted resolution of acute recurrent hepatitis B in a transplanted liver allograft by the administration of ganciclovir. , 1994, Transplantation.

[4]  M. Gaffey,et al.  Prevention of hepatitis B "rerecurrence" after a second liver transplant--the role of maintenance polyclonal HBIG therapy. , 1994, Transplantation.

[5]  M. Manns,et al.  Prostaglandin E plus famciclovir--a new concept for the treatment of severe hepatitis B after liver transplantation. , 1994, Transplantation.

[6]  S. Locarnini,et al.  In vitro antiviral activity of penciclovir, a novel purine nucleoside, against duck hepatitis B virus , 1994, Antimicrobial Agents and Chemotherapy.

[7]  H. Bodenheimer,et al.  Retransplantation in hepatitis B--a multicenter experience. , 1994, Transplantation.

[8]  K. Tsiquaye,et al.  Oral famciclovir against duck hepatitis B virus replication in hepatic and nonhepatic tissues of ducklings infected in ovo , 1994, Journal of medical virology.

[9]  B. Portmann,et al.  Impact of immunoprophylaxis and patient selection on outcome of transplantation for HBsAg-positive liver recipients. , 1994, Journal of hepatology.

[10]  W. Prince,et al.  Linear pharmacokinetics of penciclovir following administration of single oral doses of famciclovir 125, 250, 500 and 750 mg to healthy volunteers. , 1994, The Journal of antimicrobial chemotherapy.

[11]  P. Angus,et al.  Combination antiviral therapy controls severe post‐liver transplant recurrence of hepatitis B virus infection , 1993, Journal of gastroenterology and hepatology.

[12]  R. Hodge.  Famciclovir and Penciclovir. The Mode of Action of Famciclovir Including Its Conversion to Penciclovir , 1993 .

[13]  J. Lake,et al.  Liver transplantation for patients with hepatitis B: What have we learned from our results? , 1991, Hepatology.