Prevention of hepatitis B virus infection from hepatitis B core antibody-positive donor graft using hepatitis B immune globulin and lamivudine in living donor liver transplantation.
BACKGROUND
Hepatic grafts from hepatitis B surface antigen-negative and anti-core antibody (HBcAb)-positive donors have been shown to transmit hepatitis B virus (HBV) infection. Recently, it has been reported that combined hepatitis B immune globulin (HBIG) and lamivudine therapy is effective in the prevention of hepatitis B recurrence after living donor liver transplantation (LDLT). In this report, we assessed the efficacy of combined HBIG and lamivudine therapy in preventing HBV transmission by graft with HBcAb-positive donors.


METHODS
We studied 22 patients who had undergone LDLT with allografts from HBcAb-positive living donors at Gunma University Hospital and Kyushu University Hospital. Long-term combined HBIG and lamivudine therapy were administrated to all recipients. Serum samples from the donor and recipient were tested for HBcAb, HBV DNA, and hepatitis B surface antibody. Liver biopsies from grafts were tested for HBV DNA.


RESULTS
All recipients were HBcAb negative before LDLT. All of the donor livers were HBV DNA positive at the time of LDLT. All of the recipients had HBsAb titers greater than 300 mIU/ml 4 weeks after LDLT, and remained 100 mIU/ml thereafter. None of the recipients have become infected with HBV with a follow-up of 25-86 months.


CONCLUSIONS
Perioperative combined HBIG and lamivudine therapy can prevent HBV infection in recipients who receive liver grafts from HBcAb-positive donors.
Suehiro
Taketoshi
T
Department of General Surgical Science and the 21 Century COE Program, Graduate School of Medicine, Gunma University, Maebashi, Japan. tsuehiro@med.gunma-u.ac.jp
Shimada
Mitsuo
M
Kishikawa
Keiji
K
Shimura
Tatsuo
T
Soejima
Yuji
Y
Yoshizumi
Tomoharu
T
Hashimoto
Kohji
K
Mochida
Yasushi
Y
Maehara
Yoshihiko
Y
Kuwano
Hiroyuki
H
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use*; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged
D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin