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Nucleoside Analogue - Research Paper Example

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Post-transplantation Hepatitis B Prophylaxis with Combination Oral Nucleoside and Nucleotide Analog Therapy S. Saab, S. Desai, D. Tsaoi, F. Durazoa, S. Hana, A. McClune, C. Holt, D. Farmer, L. Goldstein and R. W. Busuttil Article Summary The most common strategy for thwarting Hepatitis B recurrence in the liver transplant patient is using a combination of hepatitis B immune globulin (HBIg) along with an oral antiviral agent like lamivudine…
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Download file to see previous pages Despite the remarkable success of this method, the use of lifelong HBIg for hepatitis B prophylaxis has its limitations. Among others are the high cost, limited supply and parental administration. The patient needs to frequently visit the clinic too and requires laboratory monitoring. Another problem with HBIg is it’s a blood product not readily advised by physicians. If a safer non-biological alternative existed, it would have been very easy for the patients. This particular study examined 61 patients that went under donor orthotopic liver transplantation (OLT). The study found that the HBIg cessation a 12 months minimum after the transplant with successive administration of nucleoside and nucleotide analog agent gives an effective prophylaxis against recurring HBV infection. Despite the success of the procedure concerns still persist when applying the same procedure to patients with chronic stable renal dysfunction. One recurrence case in the study seroconverted to HBsAg while being administered oral antivirals (to treat renal dysfunction). Hence renal dysfunction does represent a complication in applying this procedure. Renal toxicity is still a matter of concern regarding the long-term usage of oral antiviral drugs for preventing HBV. This study didn’t show any change in renal functional of patients however, the focus of the study was not the renal dysfunctional, studies with larger durations and follow up should be conducted to analyze this aspect comprehensively. Moreover this study doesn’t cover interaction between hepatitis delta, hepatitis C and pre-transplant hepatitis B viremia, for the risk of hepatitis B breakthrough on our protocol. Hence the oral antiviral procedure should better be performed on low risk patients. Liver transplant recipients are at a great risk of acquiring hepatitis B after liver transplantation. The transplantation performed is a preventive measure against the Hepatitis B Virus (HBV) related liver disease. This study by Saab et al. (2011) evaluates the effectiveness of the new hepatitis B prophylaxis, incorporating conversion from 12 months of HBIg along with lamivudine, to ‘combination therapy’. This was done using oral nucleotide and nucleoside analogue. During the research (between June 2008 and May 2010) 61 liver transplant recipients in total, were converted to a combination of a nucleotide and nucleoside analog. Standard deviation (or the mean) follow-up time after conversion was recorded at 15.0 (±6.1) months. Recurring HBV befell in only two patients (3.3%) at 3.1 and 16.6 months when HBIg dosage was halted. The time incidence rate for HBV relapse after terminating the HBIg was calculated at around 2.7 cases per 100 person-years. HBV relapse was estimated at 1.7% at 1 year after terminating the HBIg. The HBIg termination 12 months minimum after the liver transplantation with succeeding ‘combination therapy’ with a nucleotide and nucleoside analog, gives effective prophylaxis to fight against recurring HBV infection. The clinical associations of HBsAg findings, short of the clinical, molecular or biochemical indicators of recurring hepatitis B, require further study. One limitation of the study was it did not include a control group. All eligible patients at the center were put to dual nucleoside and ...Download file to see next pages Read More
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