Current therapeutic strategies for recurrent hepatitis B virus infection after liver transplantation

Table 1 Use of LAM in treatment of recurrent HBV graft infection after LT

Author (Ref.)	n	Pre-treatment		Treatment duration (mo) mean (range)	LAM dosage (mg/d)	Post-treatment
		HBV DNA+ (%)	HBeAg+ (%)			HBV DNA negative following treatment (%)	HBeAg seroconversion (%)	HBsAg seroconversion (%)	Development of LAM resistant mutants (%)
Ben-Ari et al[20]	8	100	62.5	36 (24-50)	100	32.5	20	0	62.5
Umeda et al[19]	61	100	NA	4.6 (0.7-11)	100	NA	NA	83.3	0
Castells et al[21]	71	100	85.7	24.5 (12-49)	100	71.4	50	14.3	14.3
Fontana et al[22]	33	94	75	21 (4-36)	NA	72	4.2	0	29.4
Andreone et al[23]	112	100	18.2	17 (8-27)	100	100	100	9.1	27.3
Perrillo et al[18]	52	90.4	86.5	12	100	68.1	11.1	3.8	26.9
Nery et al[24]	11	90.9	NA	15 (13-21)	NA	90	NA	NA	27.3
Fischer et al[25]	12	100	NA	10.5 (5-43)	100-150	83.3	NA	NA	NA
Rayes et al[26]	41	100	NA	12-36	150	75.6	NA	NA	24.4
Malkan et al[27]	41	100	75	11 (4-28)	100-150	100	NA	25	0

¹All patients had de novo HBV infection after LT;

²This study reported treatment of acute recurrent graft HBV infection. NA: Not available; HBV: Hepatitis B virus; LT: Liver transplantation; HBeAg: Hepatitis B e antigen; HBsAg: Hepatitis B surface antigen; LAM: Lamivudine.

Table 2 Use of ADV in treatment of recurrent graft infection after LT

Author (Ref.)	n	Pre-treatment		Treatment duration (mo), mean (range)	ADV dosage (mg/d)	ConcurrentLAM use	Post-treatment
		HBV DNA+ (%)	HBeAg+ (%)				HBV DNA negative following treatment (%)	HBsAg seroconversion (%)	ALT normalization (%)	Development of ADV mutants
Akyildiz et al[44]	11	81.8	9.1	18 (6-48)	10	Yes	77.8	11.1	81.8	None
Limquiaco et al[45]	7	100	71.4	35 (22-48)	10	Yes	28.6	20	86	None
Bárcena et al[46]	42	100	71.4	21.5 (12-31)	10	No	64	20	70.5	None
Herreros de Tejada Echanojáuregui et al[47]	7	100	71.4	11	10	Yes1	42.9	20	NA	None
Neff et al[48]	9	100	77.8	30 (6-48)	10	No	0	57.1	NA	None

¹LAM was changed to ADV in 5 patients and ADV was added to LAM in the other 2 patients. ADV: Adefovir dipivoxil.

Table 3 Summary of recommended therapeutic strategies for recurrent HBV infection after LT

Clinical setting	Recommended first line therapies	Recommended second line therapies
De novo HBV infection, wild-type HBV infection	LAM for short-term therapy; ADV for long-term therapy	ETV, TDF
LAM resistance	ADV, ADV + LAM	TDF
ADV resistance	ETV	TDF + LAM
Irreversible graft dysfunction	SLT

ETV: Entecavir; TDF: Tenofovir disoproxil fumarate; SLT: Second liver transplantation.