Living donor liver transplantation for hepatitis B associated liver diseases: a 10-year experience in a single center.
OBJECTIVE
Hepatic failure associated with hepatitis B virus (HBV) is one of the main indications for living donor liver transplantation (LDLT).


METHODS
Twenty-nine LDLTs, including liver cirrhosis due to HBV (LC-B) (n = 17) and fulminant hepatitis B (FH-B) (n = 12) were reviewed. Prophylaxis for reinfection was performed with a combination of lamivudine, or hepatitis B immune globulin (HBIG) or adefovir, depending on the viral status. The changes in serological markers, recurrence and survival rate were examined.


RESULTS
There were 3 patients with re-emergencies of HBV surface antigen (HBsAg): suspension of HBIG for giving vaccination for HBV (n = 1), HBsAg positive donor (n = 1) and non-compliance for HBIG (n = 1). All patients with YMDD mutants (n = 9), except the case with HBsAg positive donor (n = 1), were successfully protected by the triple therapy of lamivudine, adefovir and HBIG. No graft loss was due to the recurrence of HBV.


CONCLUSIONS
The basic strategy using a combination of HBIG and antiviral agents gave acceptable long-term outcomes for LDLT for HBV associated liver diseases. The close monitoring of HBV viral status after transplantation is still crucial in managing these patients.
Ikegami
Toru
T
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.co.jp
Soejima
Yuji
Y
Ohta
Ryuji
R
Taketomi
Akinobu
A
Yoshizumi
Tomoharu
T
Harada
Noboru
N
Kayashima
Hiroto
H
Maehara
Yoshihiko
Y
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents