Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin.
Patients undergoing liver transplantation for hepatitis B-related liver disease are prone to recurrence. The mainstay of prophylaxis has been passive immunotherapy with hepatitis B immune globulin (HBIG). Antiviral therapy with lamivudine has proven effective in lowering hepatitis B virus (HBV) DNA and improving histology in patients with hepatitis B infection; its role in prophylaxis against hepatitis B recurrence following liver transplantation is under investigation. Viral breakthrough and resistance, however, are a significant problem with monotherapy with either HBIG or lamivudine. The efficacy of combination lamivudine/HBIG prophylaxis has not been reported. Fourteen patients underwent transplantation for decompensated liver disease owing to hepatitis B. Lamivudine (150 mg p.o./d) was begun before transplantation in 10 patients, including 4 who were HBV DNA-positive. In addition, 1 patient was HBV DNA-positive when transplanted. HBIG was given perioperatively and continued thereafter; treatment with lamivudine was maintained or initiated at the time of transplantation and continued indefinitely. The median follow-up was 387 days. Actuarial 1-year patient and graft survival was 93% (1 patient died of unrelated causes). At a median interval of 28 days following lamivudine treatment, all 5 HBV DNA-positive patients cleared HBV DNA from the serum; 1 went on to clear hepatitis B surface antigen (HBsAg), before transplantation, at day 148 of lamivudine treatment. By the highly sensitive polymerase chain reaction (PCR), at a median of 346 days (range, 130-525 days) following transplantation, all 13 surviving patients had no detectable serum HBV DNA. Lamivudine suppresses HBV replication in patients awaiting liver transplantation. At a median follow-up of 1.1 years, combination prophylaxis with lamivudine and HBIG prevented hepatitis B recurrence following liver transplantation.
The Dumont-UCLA Transplant Center and the Division of Liver and Pancreas Transplantation, UCLA Medical Center, Los Angeles, CA 90095, USA.
J S
JS
Markowitz
P
P
Martin
A J
AJ
Conrad
J F
JF
Markmann
P
P
Seu
H
H
Yersiz
J A
JA
Goss
P
P
Schmidt
A
A
Pakrasi
L
L
Artinian
N G
NG
Murray
D K
DK
Imagawa
C
C
Holt
L I
LI
Goldstein
R
R
Stribling
R W
RW
Busuttil
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000517:prevention & control* / Q000628:therapy / Q000821:virology; D006515:Hepatitis B virus / Q000502:physiology; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins; D019259:Lamivudine / Q000627:therapeutic use*; D008099:Liver / Q000503:physiopathology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention; D014779:Virus Replication / Q000187:drug effects
D007136:Immunoglobulins; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin