The addition of mycophenolate mofetil for suppressing hepatitis B virus replication in liver recipients who developed lamivudine resistance - No beneficial effect

Background. Mycophenolate mofetil is used as an immunosuppressive agent in liver transplant recipients. Its active compound, mycophenolic acid, also i nhibits the replication of Epstein-Barr virus and human immunodeficiency vi rus. Based on a study indicating the effectiveness of mycophenolate mofetil on hepatitis B virus (HBV) replication in infected human hepatocyte cells in culture, we examined the efficacy of mycophenolate mofetil in suppressin g HBV replication in lamivudine-resistant liver allograft recipients with r ecurrent HBV infection. Method. The study population included four liver allograft recipients (thre e males, one female), median age 51 years (range 41-57 years), with recurre nt HBV infection who proved to be resistant to lamivudine. All received sta ndard maintenance immunosuppression therapy. Median pretreatment serum alan ine aminotransferase level was 75 muL (range 39-182 muL) and HBV DNA level (quantitative dot blot), 70 pg/ml (range: 10-5000 pg/ml). Mycophenolate mof etil, 1.0 g p.o. twice daily, mas administered for 8 weeks, concomitant wit h a reduction in the maintenance corticosteroid and cyclosporine doses. Results. After mycophenolate mofetil was administered, the serum alanine am inotransferase level increased in two patients, did not change in one, and decreased in one. Serum HBV DNA levels increased in three patients and decr eased (nonsignficantly) in only one patient. Two patients complained of abd ominal pain and nausea. Conclusions. Mycophenolate mofetil at the dosage used is not effective in s uppressing HBV replication after liver transplantation.