Case Report
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World J Hepatol. Dec 27, 2010; 2(12): 442-446
Published online Dec 27, 2010. doi: 10.4254/wjh.v2.i12.442
Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil
Masami Minemura, Yoshiharu Tokimitsu, Kazuto Tajiri, Yasuhiro Nakayama, Kengo Kawai, Hiroshi Kudo, Katsuharu Hirano, Yoshinari Atarashi, Yutaka Yata, Satoshi Yasumura, Terumi Takahara, Toshiro Sugiyama
Masami Minemura, Yoshiharu Tokimitsu, Kazuto Tajiri, Yasuhiro Nakayama, Kengo Kawai, Hiroshi Kudo, Katsuharu Hirano, Yoshinari Atarashi, Yutaka Yata, Satoshi Yasumura, Terumi Takahara, Toshiro Sugiyama, Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
Author contributions: Minemura M wrote the paper; Tokimitsu Y, Tajiri K, Nakayama Y, Kawai K, Kudo H, Hirano K, Atarashi Y and Yata Y performed the research; and Yasumura S, Takahara T and Sugiyama T designed the research.
Correspondence to: Masami Minemura, MD, PhD, Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan. minemura-tym@umin.ac.jp
Telephone: +81-76-4347301 Fax: +81-76-4345027
Received: July 21, 2010
Revised: October 11, 2010
Accepted: October 18, 2010
Published online: December 27, 2010
Abstract

We report the case of a patient treated with living donor-related liver transplantation who suffered from osteomalacia during adefovir dipivoxil (ADV)-containing antiviral therapy for lamivudine-resistant hepatitis B virus infection. The patient had generalized bone pain, with severe hypophosphatemia after 20 mo of ADV therapy. Radiographic studies demonstrated the presence of osteomalacia. The peak plasma ADV level was 38 ng/mL after administration of ADV at 10 mg/d. It was also found that ADV affected the metabolism of tacrolimus, a calcineurin-inhibitor, and caused an increase in the plasma levels of tacrolimus. The disability was reversed with the withdrawal of ADV and with mineral supplementation. ADV can cause an elevation of plasma tacrolimus levels, which may be associated with renal dysfunction. High levels of ADV and tacrolimus can cause nephrotoxicity and osteomalacia. This case highlights the importance of considering a diagnosis of osteomalacia in liver transplantation recipients treated with both ADV and tacrolimus.

Keywords: Hepatitis B virus; Osteomalacia; Adefovir dipivoxil; Living donor-related liver transplantation; Tacrolimus