Living donor liver transplantation for hepatitis B cirrhosis.
OBJECTIVE
Living donor liver transplantation (LDLT) has particular advantages for Turkey where hepatitis B virus (HBV) infection is the most common cause of cirrhosis, both because LDLT circumvents the difficulties encountered in the emerging world in providing deceased donor organs, and because it allows preemptive antiviral therapy. The aim of this study was to review one institution's experience with LDLT in patients with chronic HBV infection.


METHODS
A total of 109 patients with chronic HBV infection underwent LDLT between September 1999 and June 2005, of whom 40 were coinfected with hepatitis D virus and 23 had hepatocellular carcinoma. Antiviral prophylaxis was attempted in all, beginning prior to transplantation with lamivudine or adefovir, and continuing after transplantation with low dose intramuscular hyperimmune B immunoglobulin (HBIg) plus lamivudine or adefovir.


RESULTS
In a median follow up of 20 months (range 1-66 months), there was no donor mortality. One-year recipient survival was 90%, and in total 16 recipients died. None of the deaths was related to HBV. Recurrence of HBV infection was detected by reappearance of serum hepatitis B surface antigen in six patients (5.5%) at 5, 8, 12, 17, 34 and 46 months after transplantation, respectively. There was no influence of donor hepatitis B core antibody status on the likelihood of recurrence of HBV in the allograft.


CONCLUSIONS
The results indicate that LDLT with antiviral treatment and low dose HBIg provides excellent results for donors and recipients.
Karasu
Zeki
Z
Department of Gastroenterology, Ege University Medical School, Bornova, Izmir, Turkey.
Akyildiz
Murat
M
Kilic
Murat
M
Zeytunlu
Murat
M
Aydin
Unal
U
Tekin
Fatih
F
Yilmaz
Funda
F
Ozacar
Tijen
T
Akarca
Ulus
U
Ersoz
Galip
G
Gunsar
Fulya
F
Ilter
Tankut
T
Lucey
Michael R
MR
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications* / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests