Preoperative antiviral treatment and postoperative prophylaxis in HBV-DNA positive patients undergoing liver transplantation.
BACKGROUND
Despite passive immunoprophylaxis a significant number of patients, especially if hepatitis B virus (HBV) DNA is positive prior to transplantation, develop HBV recurrence. This number might be reduced by lowering viral replication pretransplant with antiviral agents and by postoperative combination of antiviral agents and passive immunoprophylaxis.


METHODS
A total of 74 HBV-DNA positive patients who underwent liver transplantation between 9/88 and 4/00 were analyzed retrospectively. Before lamivudine or famciclovir were available, in total 40 patients did not receive any preoperative antiviral therapy. Since 11/93, 17 patients were treated with famciclovir 1500 mg daily, after 4/96 17 patients with lamivudine 150 mg daily prior liver transplantation. Posttransplant all patients received passive immunoprophylaxis aiming at a titer of more than 100 U/liter. In the 34 patients with preoperative antiviral therapy an additional prophylaxis with the respective antiviral agent was applied.


RESULTS
Under preoperative famciclovir and lamivudine 30 and 71% of patients became HBV-DNA negative, respectively. Actuarial reinfection rate 2 years after liver transplantation was 48% without antiviral prophylaxis, which was not statistically different from 55% under perioperative famciclovir therapy. In contrast only 18% developed HBV recurrence under perioperative lamivudine treatment. During both antiviral regimens neither pre nor posttransplant severe side effects were observed.


CONCLUSIONS
Perioperative application of famciclovir is not recommendable, whereas lamivudine seems to lower recurrence rates significantly. Whether the observed effect is due to pre- or postoperative application remains to be addressed in further studies. In addition the long-term course has to be awaited.
Seehofer
D
D
Department of Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, D-13353 Berlin, Germany.
Rayes
N
N
Naumann
U
U
Neuhaus
R
R
Müller
A R
AR
Tullius
S G
SG
Berg
T
T
Steinmüller
T
T
Bechstein
W O
WO
Neuhaus
P
P
D015075:2-Aminopurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis*; D000077595:Famciclovir; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology; D019259:Lamivudine / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies
D000998:Antiviral Agents; D004279:DNA, Viral; D007136:Immunoglobulins; D019259:Lamivudine; D015075:2-Aminopurine; D000077595:Famciclovir; C045213:hepatitis B hyperimmune globulin