Prevention of de novo hepatitis B virus infection in living donor liver transplantation using hepatitis B core antibody positive donors.
Exclusion of liver grafts from hepatitis B core antibody (anti-HBc) positive donors to prevent de novo hepatitis B virus (HBV) infection after liver transplantation is not feasible in areas highly endemic for HBV virus like Taiwan, where approximately 80% of adults are anti-HBc(+). The efficacy of lamivudine monotherapy to prevent de novo HBV infection after living donor liver transplantation (LDLT) using grafts from anti-HBc(+) donors remains to be elucidated. From June 1994 to August 2000, LDLT was performed in 42 recipients. Twenty-four of the 42 donors were anti-HBc(+) (57%). Pre-transplant HBV vaccination was given to all recipients irrespective of anti-HBc status at monthly intervals for 3 months. Until December 1997, eight recipients received liver grafts from anti-HBc(+) donors without prophylaxis. Since January 1998, prophylaxis with lamivudine monotherapy was given to 16 recipients receiving liver grafts from anti-HBc(+) donors. De novo HBV infection occurred in three of the eight recipients (37.5%) who did not receive prophylaxis, while none of the 16 recipients given lamivudine developed de novo HBV infection after a mean follow-up of 25 months. Two of the three recipients with de novo HBV infection were anti-HBs(-) and one recipient was anti-HBs(+). Lamivudine was well tolerated, and no side effects were noted. These results suggest that lamivudine monotherapy for recipients receiving anti-HBc(+) liver grafts is a simple, relatively inexpensive and effective prophylactic regimen for prevention of de novo HBV infection. The additive protection provided by vaccine-induced or natural immunity is uncertain.
Chen
Yaw-Sen
YS
Department of Surgery, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
Wang
Chih-Chi
CC
de Villa
Vanessa H
VH
Wang
Shih-Hor
SH
Cheng
Yu-Fan
YF
Huang
Tung-Liang
TL
Jawan
Bruno
B
Chiu
King-Wah
KW
Chen
Chao-Long
CL
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D006509:Hepatitis B / Q000517:prevention & control*; D006512:Hepatitis B Core Antigens; D006801:Humans; D007223:Infant; D019259:Lamivudine / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000379:methods; D019520:Living Donors; D012189:Retrospective Studies
D000998:Antiviral Agents; D006512:Hepatitis B Core Antigens; D019259:Lamivudine