Liver transplantation in Asian patients with chronic hepatitis B using lamivudine prophylaxis.
OBJECTIVE
To report the results of liver transplantation in 31 Asian patients with chronic hepatitis B using lamivudine prophylaxis in an open-label study.


BACKGROUND
Chronic hepatitis B is a prevalent cause of end-stage liver disease in Asia, but the results of liver transplantation in these patients are poor.


METHODS
Thirty-one Asian patients with chronic hepatitis B underwent liver transplantation using lamivudine prophylaxis (100 mg daily). Twenty-three (74%) patients had detectable serum hepatitis B envelope antigen (n = 18) or hepatitis B virus DNA (n = 11) before treatment, and seven had associated hepatocellular carcinoma. Lamivudine was continued indefinitely after transplantation, and hepatitis B immune globulin was not used.


RESULTS
The actuarial patient and graft survival rates were 84% and 81%, respectively. Five patients died of causes unrelated to hepatitis B, and 26 patients were alive at a median follow-up of 16 months (range 6-47) after transplantation. One (3.8%) patient developed recurrent hepatitis B resulting from viral breakthrough at week 53 and survived after retransplantation using adefovir and hepatitis B immune globulin treatment. The remaining 25 surviving patients had no biochemical or histologic evidence of recurrent hepatitis, and serum hepatitis B virus DNA remained negative by polymerase chain reaction. In six patients, hepatitis B surface antigen (HBsAg) persisted or reappeared in serum. Among 19 patients who became negative for HBsAg from 5 to 431 days after transplantation, 13 developed anti-HBsAb that lasted a median of 6 months (range 1-21). None of the seven patients with hepatocellular carcinoma developed recurrent tumor.


CONCLUSIONS
Asian patients with chronic hepatitis B may achieve a good outcome after liver transplantation using lamivudine prophylaxis.
Lo
C M
CM
Centre of Liver Diseases, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. chungmlo@hkucc.hku.hk
Cheung
S T
ST
Lai
C L
CL
Liu
C L
CL
Ng
I O
IO
Yuen
M F
MF
Fan
S T
ST
Wong
J
J
D000293:Adolescent; D000328:Adult; D005260:Female; D006084:Graft Rejection; D006509:Hepatitis B / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery*; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006723:Hong Kong; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention; D016896:Treatment Outcome
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine