Lamivudine after hepatitis B immune globulin is effective in preventing hepatitis B recurrence after liver transplantation.
The prevention of recurrent hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT) with hepatitis B immunoglobulin (HBIG) is expensive and requires indefinite parenteral administration. Lamivudine is a nucleoside analogue capable of inhibiting HBV replication. The aim of this study is to determine the efficacy of lamivudine in the prevention of recurrent HBV infection after a course of HBIG in patients who were hepatitis B surface antigen (HBsAg) positive and hepatitis Be antigen (HBeAg) negative before OLT. Patients at high risk for recurrent HBV infection (HBeAg positive and HBV DNA positive) were excluded. Thirty HBsAg-positive, HBeAg-negative patients underwent OLT from January 1993 to June 1997. All 30 patients were administered HBIG after OLT and, after 2 years, were given the option of continuing with HBIG or switching to lamivudine. Five patients were excluded: 3 patients were lost to follow-up and 2 patients died of technical complications. Three patients terminated HBIG therapy at 8, 24, and 29 months after OLT, and reinfection with HBV occurred in 1 patient. Six patients elected to continue HBIG therapy for life; 1 patient died of melanoma and the remaining 5 patients are HBsAg negative, with an average follow-up of 73 months. Sixteen patients were converted to lamivudine after a course of HBIG, and all 16 patients are HBsAg negative, with an average follow-up of 51 months after OLT. Five patients have been on lamivudine monotherapy for more than 24 months. These results suggest that lamivudine administered after a posttransplantation course of HBIG can effectively prevent the recurrence of HBV infection in patients who are HBsAg positive and HBeAg negative before OLT.
Dodson
S F
SF
Thomas E. Starzl Transplantation Institute, Pittsburgh, PA 15213, USA.
de Vera
M E
ME
Bonham
C A
CA
Geller
D A
DA
Rakela
J
J
Fung
J J
JJ
D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000209:etiology / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D055502:Secondary Prevention
D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin