Failure of ganciclovir prophylaxis to prevent allograft reinfection following orthotopic liver transplantation for chronic hepatitis B infection.
The effect of ganciclovir prophylaxis on reinfection of hepatic allografts by hepatitis B virus (HBV) was studied in 26 patients undergoing orthotopic liver transplantation (OLT) for decompensated cirrhosis due to HBV. Patients were randomized to receive either ganciclovir (6 mg/kg/day intravenously for a total of 100 days) or acyclovir (10 mg/kg every 8 hours intravenously until discharged and then 800 mg orally every 6 hours) for a total of 100 days after OLT as part of a study of prophylaxis against cytomegalovirus infection. All patients received hepatitis B immunoglobulin (HBIG), 10,000 units intravenously, during the anhepatic phase, daily for the first 7 days, after OLT, and then every 4 weeks for 6 months, Seven of 12 (58%) patients in the ganciclovir group developed recurrent HBV, compared with 6/14 (46%) of the acyclovir group (nonsignificant). No significant difference was observed in time to recurrent HBV in the ganciclovir group (mean 13.2 months) compared to the acyclovir group (mean 11 months). Our results suggest that ganciclovir administered prophylactically for 100 days after OLT does not prevent or delay graft reinfection by HBV.
Jurim
O
O
Dumont-UCLA Liver Transplant Program, UCLA School of Medicine 90024-1749, USA.
Martin
P
P
Winston
D J
DJ
Shackleton
C
C
Holt
C
C
Feller
J
J
Csete
M
M
Shaked
A
A
Imagawa
D
D
Olthoff
K
K
Lau
J Y
JY
Busuttil
R W
RW
D000212:Acyclovir / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001483:Base Sequence; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006084:Graft Rejection / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control / Q000821:virology; D006085:Graft Survival / Q000187:drug effects*; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D007262:Infusions, Intravenous; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D015996:Survival Rate; D014184:Transplantation, Homologous; D017211:Treatment Failure
D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir