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Title: Post-liver transplant hepatitis B prophylaxis: the role of oral nucleos(t)ide analogues.
Austin Authors: Patterson, Scott J ;Angus, Peter W 
Affiliation: Victorian Liver Transplant Unit, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia
Issue Date: 1-Jun-2009
Publication information: Current Opinion in Organ Transplantation; 14(3): 225-30
Abstract: The established gold standard for prophylaxis against hepatitis B virus (HBV) recurrence post-liver transplant is combination hepatitis B immune globulin (HBIG) and lamivudine. This therapy reduces the risk of recurrence to less than 5% at 5 years; however, the cost of HBIG has led to the investigation of alternatives. This paper reviews the HBIG-sparing alternatives achieved with lamivudine and the prospects for the newer anti-HBV agents in post-liver transplant prophylaxis.When used with lamivudine as part of combination prophylaxis, low-dose intramuscular HBIG is equivalent to high-dose intravenous HBIG. There is recent evidence that in patients receiving HBIG/lamivudine, HBIG can be replaced with adefovir dipivoxil at 6-12 months post-liver transplant without precipitating recurrence. Furthermore, a recent study showed that primary prophylaxis with combination adefovir/lamivudine therapy without the use of long-term HBIG was effective and well tolerated as primary prophylaxis.Although there are few studies of potent newer anti-HBV agents such as entecavir or tenofovir being used as HBV prophylaxis, the properties of these drugs suggest that they should replace lamivudine within HBV prophylaxis regimes.
Gov't Doc #: 19373086
DOI: 10.1097/MOT.0b013e32832b1f32
Type: Journal Article
Subjects: Adenine.administration & dosage.analogs & derivatives
Administration, Oral
Antiviral Agents.administration & dosage.adverse effects
Drug Administration Schedule
Drug Therapy, Combination
Graft Survival.drug effects
Guanine.administration & dosage.analogs & derivatives
Hepatitis B.prevention &
Immunoglobulins.administration & dosage
Injections, Intramuscular
Lamivudine.administration & dosage
Liver Transplantation.adverse effects
Nucleosides.administration & dosage.adverse effects
Nucleotides.administration & dosage.adverse effects
Organophosphonates.administration & dosage
Secondary Prevention
Treatment Outcome
Appears in Collections:Journal articles

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