Prevention of hepatitis B virus recurrence after liver transplantation in cirrhotic patients treated with lamivudine and passive immunoprophylaxis.
OBJECTIVE
Treatment with hepatitis B virus immune globulins (HBIG) or lamivudine has reduced the rate of hepatitis B recurrence after liver transplantation to approximately 50%.


METHODS
To further decrease hepatitis B recurrence, 33 hepatitis B virus (HBV)-related cirrhotic patients were treated with lamivudine before liver transplantation and with lamivudine together with low-dose HBIG (46 500 IU the first month followed by 5,000 lU/monthly) after surgery.


RESULTS
While on lamivudine, serum HBV DNA level decreased significantly in all patients and in 11 (33%) the Child-Pugh score improved. Twenty-six patients were transplanted. Among the 25 who survived for longer than 12 months, only one (4%) experienced a hepatitis B recurrence over an average follow-up of 31 months, a rate significantly lower (P = 0.0002) than the 50% recurrence rate among a historical control group of 12 patients. However, low-level HBV replication was detected sporadically throughout the follow-up in 64% of patients.


CONCLUSIONS
Over the medium-term, combined prophylaxis with lamivudine and HBIG significantly decreases the risk of hepatitis B recurrence after liver transplantation. Though low-level HBV infection recurred in two thirds of patients, the pathogenic expression of HBV was prevented.
Marzano
A
A
Department of Gastroenterology, Azienda Molinette, Turin, Italy. alfredomarzano@usa.net
Salizzoni
M
M
Debernardi-Venon
W
W
Smedile
A
A
Franchello
A
A
Ciancio
A
A
Gentilcore
E
E
Piantino
P
P
Barbui
A M
AM
David
E
E
Negro
F
F
Rizzetto
M
M
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control* / Q000628:therapy / Q000821:virology; D006510:Hepatitis B Antibodies / Q000627:therapeutic use*; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012008:Recurrence
D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D007136:Immunoglobulins; D019259:Lamivudine