Source Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, United States.

Lamivudine (LAM) has been shown to prevent de novo hepatitis B virus (HBV) infection in liver transplant (LT) recipients of HBV core antibody positive (HBcAb+) grafts, but may produce resistance long-term. Adefovir dipivoxil (ADV) might be effective in preventing de novo hepatitis and resistance. A single-center prospective trial was conducted of 16 adults (mean age 54.4±11.1 years, 10 men) who underwent LT with HBcAb+ grafts between September 2007 and October 2009. Post-LT, patients were given ADV (10 mg daily, adjusted for renal function). No hepatitis B immune globulin (HBIG) was administered. At LT, all graft recipients were HBV surface antigen negative (HBsAg-), 38% surface antibody positive (HBsAb+) and 50% HBcAb+. Median follow-up post-LT was 1.8 years (range 0.9-2.6). All recipients had undetectable HBV DNA (/40 IU/mL) post-LT until the end of follow-up. Post-LT, one recipient (6%) who was HBsAb-/HBcAb- pre-LT developed HBsAg+ after 52 weeks. One recipient was switched from ADV to entecavir for chronic renal insufficiency and 19% had renal dose adjustments. There was a non-significant trend towards an increasing creatinine over time (1.2 mg/dL at LT, 1.3 mg/dL at 1-year post-LT, and 2.0 mg/dL at 2-years post-LT, p=0.27). When compared to a control cohort of LT recipients with HCV that did not receive ADV, there was no difference in creatinine at LT and 1-year post-LT. ADV prophylaxis prevents HBV replication in recipients of HBcAb+ livers, but does not fully protect recipients from de novo HBV. Long-term follow-up is needed to better determine the risk of de novo infection.