title: Lamivudine treatment for hepatitis B reactivation in HBsAg carriers after organ transplantation: a 4-year experience.
abstract: BACKGROUND
  Reactivation of hepatitis B after organ transplantation in hepatitis B surface antigen (HBsAg) carriers may be fatal. In this study, we reported our experience of lamivudine treatment in HBsAg carriers who had post-transplant reactivation of hepatitis B.
  
  
  METHODS
  The patients were 15 men and one woman. Nine received kidney transplants, six received heart transplants, and one received a lung transplant. They developed a reactivation of hepatitis B 1-101 months (median, 14 months) after transplantation. They received lamivudine 100 mg daily on a compassionate-use basis, and had regular follow ups. The median pretreatment total serum bilirubin level was 3.0 mg/dL, and the alanine aminotransferase level was 357 U/L. Four of the 16 patients were positive for HBeAg. The serum hepatitis B virus (HBV) DNA levels were > 3000 pg/mL in 13 (81%) patients. Three were coinfected with hepatitis C virus.
  
  
  RESULTS
  The overall survival rate was 75%. All four fatal cases had a pretreatment total serum bilirubin level of > or = 3 mg/dL. Serum HBV-DNA soon became undetectable in 12 survivors. Of the 12 survivors, after a median treatment period of 101 weeks, a lamivudine-resistant strain with variation in the YMDD motif of the HBV polymerase gene developed in three (25%). None had significant adverse reactions to lamivudine treatment.
  
  
  CONCLUSIONS
  These results indicated that lamivudine is effective in the treatment of post-transplant hepatitis B reactivation, including patients with dual chronic hepatitis B and C. Early recognition of HBV reactivation and prompt lamivudine treatment are important to prevent mortality.
authors.affiliation: Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: C J
authors.initials: CJ
authors.lastname: Liu
authors.forename: M Y
authors.initials: MY
authors.lastname: Lai
authors.forename: P H
authors.initials: PH
authors.lastname: Lee
authors.forename: N K
authors.initials: NK
authors.lastname: Chou
authors.forename: S H
authors.initials: SH
authors.lastname: Chu
authors.forename: P J
authors.initials: PJ
authors.lastname: Chen
authors.forename: J H
authors.initials: JH
authors.lastname: Kao
authors.forename: Y M
authors.initials: YM
authors.lastname: Jen
authors.forename: D S
authors.initials: DS
authors.lastname: Chen
mesh_terms: D000328:Adult; D002353:Carrier State / Q000188:drug therapy* / Q000276:immunology; D004279:DNA, Viral / Q000097:blood; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D019259:Lamivudine / Q000009:adverse effects / Q000627:therapeutic use*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D014181:Transplantation Immunology; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine