Summary
Antiviral treatment can be complex in decompensated hepatitis B virus (HBV) cirrhosis because of potential emergence of lamivudine‐resistant mutants and worsening liver function, and to multifactorial nephrotoxicity. Negative HBV‐DNA status by hybridization before liver transplantation is a favorable prognostic factor. We present the case of a 54‐year‐old HBV+ liver transplantation candidate who, after testing negative for HBV‐DNA, developed YMDD lamivudine‐resistant mutants resulting in a deteriorated clinical condition. After 8 months of adefovir plus lamivudine double therapy, only partial response was achieved. Tenofovir was added to this regimen, and an early decline of HBV‐DNA was seen at 4 weeks without adverse events. The patient underwent transplantation. At 21‐month postoperative follow‐up, the patient's outcome was excellent. Post‐transplantation HBV prophylaxis, taking into account the prior development of mutants, consists of hepatitis B immunoglobulin plus lamivudine and adefovir. Tenofovir was well tolerated and produced a fast antiviral response, suggesting its potential value in combined antiviral treatment for liver transplantation candidates.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.