Preoperative lamivudine therapy in HBV DNA positive recipients: is it always necessary?
OBJECTIVE
Long-term preoperative lamivudine therapy has been recommended for patients with positive HBV DNA to suppress HBV replication before liver transplantation. However, it is unclear whether preoperative lamivudine therapy is mandatory in HBV DNA positive patients to reliably prevent HBV recurrence or whether transplantation should be delayed to allow time for sufficient preoperative lamivudine therapy.


METHODS
From January 2000 to January 2004, thirty-eight patients serum positive for HBV DNA who survived more than 3 months after transplantation and received postoperative combination prophylaxis with hepatitis B immune globulin and lamivudine were enrolled.


RESULTS
Total 2-year recurrence rate was 8.7%. When these 38 patients were divided into two groups according to preoperative lamivudine therapy duration: group 1 (n = 11) 4 weeks or more and group 2 (n = 27) less than 4 weeks, recurrences were detected in 3 (27.2%) and 4 (14.8%) patients in groups 1 and 2, respectively, i.e. a similar recurrence rate in both groups (p = 0.390). Moreover, in a subgroup of 20 patients who received preoperative lamivudine therapy for less than one week, only one (5%) experienced HBV recurrence.


CONCLUSIONS
Our findings indicate that postoperative combination prophylaxis is effective and that preoperative lamivudine therapy is unlikely to be obligatory despite a positive preoperative serum HBV DNA status.
Lee
Hae Won
HW
Department of Surgery, Seoul National University, College of Medicine, Seoul National University Hospital, Seoul, Korea.
Suh
Kyung-Suk
KS
Yi
Nam-Joon
NJ
Yang
Sung Hoon
SH
Cho
Eung-Ho
EH
Cho
Jai Young
JY
Kwon
Choon Hyuck
CH
Cho
Yong Beom
YB
Lee
Kuhn Uk
KU
D000328:Adult; D004279:DNA, Viral / Q000097:blood / Q000378:metabolism*; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D006801:Humans; D007136:Immunoglobulins / Q000737:chemistry; D007166:Immunosuppressive Agents; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012008:Recurrence; D016896:Treatment Outcome
D004279:DNA, Viral; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D019259:Lamivudine