[Prevention and treatment of hepatitis B recurrence after liver transplantation].
OBJECTIVE
To investigate the effect of the regimen of lamivudine (LAM) combined with hepatitis B immunoglobulin (HBIG) in prevention and treatment of re-infection of hepatitis B virus (HBV) and recurrence of hepatitis B after orthotopic liver transplantation (OLT) for HBV related end stage liver disease.


METHODS
The clinical data of 183 adult liver transplantation patients who lived more than 6 months and were followed up for 14.6 months with complete data were studied retrospectively. According to the HBV prevention strategy, these recipients were divided into two groups: group of pure LAM (n = 106) and group of LAM plus intramuscular injection of low dose HBIG (n = 77).


RESULTS
The rate of HBsAg negative conversion 1 week after OLT of the LAM group was 82.10% (87/106), significantly lower than that of the LAM + HBIG group [94.81% (73/77), P = 0.010]. The rates of HBV reinfection, HB recurrence, and YMDD mutation of the lamivudine group were 16.98% (18/106), 11.32% (12/106), and 8.49% (9/106) respectively, all significantly higher than those of the LAM + HBIG group [6.49% (5/77), 2.60% (2/77), and 1.30% (1/77) respectively, P = 0.035, 0.028, and 0.035 respectively]. All the patients with YMDD mutation were treated with adefovir (ADF) with improvement. Analysis showed no obvious difference in the effect of LAM given intramuscularly or intravenously.


CONCLUSIONS
The protocol of combination of LAM and HBIG is highly effective, safe, and cost-effective in preventing the recurrence of HBV after OLT. YMDD mutation can be treated by ADF with satisfactory results.
Zhang
Xiang-liang
XL
Department II of Abdominal Surgery Affiliated Tumor Hospital of Guangzhou Medical College, Guangzhou 510095, China.
Zhu
Xiao-feng
XF
Shi
Hui-juan
HJ
Cui
Shu-zhong
SZ
Tang
Yun-qiang
YQ
Ba
Ming-chen
MC
Wang
Jia-kang
JK
Wang
Bin
B
Lu
Qin
Q
Zhao
Hong-yu
HY
Wu
Yin-bing
YB
Li
Mei-lu
ML
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000209:etiology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D055502:Secondary Prevention
D000998:Antiviral Agents; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin