Famciclovir treatment in transplant recipients with HBV-related liver disease: disappointing results

OBJECTIVE:Long-term administration of hepatitis B immune globulin is effective as prophylaxis for hepatitis B virus (HBV) reinfection but is limited by cost, side effects, availability and a failure rate of 20%. Famciclovir has been shown to be effective in the treatment of hepatitis B in the immunocompetent patient. Fewer data exist in the liver transplant setting, particularly regarding its efficacy in de novo HBV infection. The aims of this pilot study were to determine the effectiveness and safety of long-term administration of famciclovir in recurrent (n = 3) and de novo (n = 3) HBV infection after liver transplantation.METHODS:Six patients with postransplant HBV infection (positivity of serum HBsAg and HBV DNA), four of whom were HBeAg positive, were treated with famciclovir (500 mg, 3 times a day) with a minimum follow-up period of 12 months. Biochemical, serological, virological (HBV DNA by hybridization assays and polymerase chain reaction), and histological (including HBV immunostaining) endpoints were evaluated.RESULTS:None of the patients had a complete biochemical response, with a near complete normalization of ALT levels being observed in 3/6 patients. There was a lack of correlation between virological and biochemical responses. None of the patients seroconverted to anti-HBs or anti-HBe. A virological clearance was observed in only two patients, whereas a moderate reduction in HBV DNA levels was present in one. HBV DNA levels were higher than levels during pretreatment in the three remaining patients. Histological improvement was only observed in one patient.CONCLUSION:Famciclovir alone appears of limited efficacy in the treatment of HBV infection after liver transplantation.