Recurrence of hepatitis B in liver transplants treated with antiviral therapy.
OBJECTIVE
In patients with terminal Hepatitis B Virus-related liver diseases, liver transplantation carries a consistent risk of Hepatitis B Virus recrudescence in the graft. In the attempt to reduce the reinfection rate with antiviral therapy, we studied a total of 16 viraemic patients.


METHODS
Twelve patients received Ganciclovir, starting 4-67 days (mean 25 days) before transplantation and prolonged for 10 days after transplantation; four patients were treated with Lactosaminated Arabinoside-Monophosphate 6 hours before surgery and prolonged for 28 days after surgery. All received hepatitis B immunoglobulins.


RESULTS
At transplantation, HBV-DNA had decreased to about 10(4) virus/ml (as assessed by the polymerase chain reaction assay) in 10 of the 12 patients treated with Ganciclovir. Of these patients, 4 died perioperatively from causes unrelated to Hepatitis B Virus reinfection. Of the eight survivors, only the patient who maintained a titre of 10(6) virus/ml at the time of transplantation developed viral recurrence 4 months after surgery. Before transplantation, 2 of the patients treated with Lactosaminated Arabinoside-Monophosphate had a viraemic load of 10(6) and 2 of 10(4) virus/ml. In all cases, viraemia became undetectable at the end of therapy. None died and Hepatitis B Virus recurred 2 months after transplantation in one. The overall rate of Hepatitis B Virus recurrence was 16.6%. The recurrence rate decreased to 9% in patients in whom the viraemic load decreased to around 10(4) virus/ml following treatment, compared to an overall recurrence rate of 50% in our historical series of patients transplanted for Hepatitis B Virus-related cirrhosis.


CONCLUSIONS
Antiviral therapy was effective in decreasing the risk of Hepatitis B Virus reinfection of the liver graft by decreasing the viral load before surgery.
Marzano
A
A
Department of Gastroenterology, Molinette Hospital, Turin, Italy.
Debernardi-Venon
W
W
Smedile
A
A
Brunetto
M R
MR
Torrani Cerenzia
M R
MR
Actis
G C
GC
Zamboni
F
F
Ghisetti
V
V
Piantino
P
P
David
E
E
Salizzoni
M
M
Rizzetto
M
M
D000328:Adult; D000606:Amino Sugars / Q000008:administration & dosage / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017931:DNA Primers / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006509:Hepatitis B / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D006510:Hepatitis B Antibodies / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007262:Infusions, Intravenous; D017093:Liver Failure / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011107:Polylysine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate; D001084:Vidarabine Phosphate / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014766:Viremia / Q000188:drug therapy / Q000209:etiology / Q000401:mortality
D000606:Amino Sugars; D000998:Antiviral Agents; D017931:DNA Primers; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; C086198:lactosaminated polylysine-adenine arabinoside monophosphate; D001084:Vidarabine Phosphate; D011107:Polylysine; D015774:Ganciclovir