Role of long-term lamivudine treatment of hepatitis B virus recurrence after liver transplantation.
In this study, the long-term (>3 years) efficacy of combination therapy for hepatitis B virus (HBV) recurrence and the associated factors were investigated. One hundred and sixty-five consecutive HBsAg-positive patients (92 with liver cirrhosis, 73 with hepatocellular carcinoma; HCC) who underwent liver transplantation were assessed with a median follow-up time of 40 months. One hundred and twenty-one patients (121/165, 73.3%) were treated with lamivudine before transplantation for a mean of 8.4 months (range 0.1-72 months). The post-transplantation treatment protocol consisted of a high dose intravenous hepatitis B immunoglobulin (HBIg) followed by a low dose intramuscular HBIg and lamivudine combination therapy. Seven (4.2%, 7/165) recipients experienced HBV recurrence at a median time of 19 months (range 5-36 months) following transplantation. Six of seven cases of HBV recurrence were treated with lamivudine before transplantation for a median period of 15 months (range 0.6-30 months). Eighteen (24.6%, 18/73) patients had HCC recurrences after transplantation. Of the four patients with both HCC and HBV recurrence, three experienced HBV recurrence after recurrence of HCC. The clinical factor associated with HBV recurrence in the total cohort (n = 165) was the duration of antiviral treatment (over 6 months) before transplantation (P = 0.004). In the HCC group, HCC recurrence after transplantation (P = 0.002), tumor burden before transplantation (P = 0.005), and postoperative adjuvant chemotherapy (P = 0.002), were additional factors for HBV recurrence. Combination therapy of HBIg and antiviral drugs was effective over 3 years regardless of the pretransplantation viral load. However, the possible recurrence of HBV needs to be monitored cautiously in patients treated with long-term (over 6 months) lamivudine.
Woo
Hyun Young
HY
Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.
Choi
Jong Young
JY
Jang
Jeong Won
JW
You
Chan Ran
CR
Bae
Si Hyun
SH
Yoon
Seung Kew
SK
Yang
Jin Mo
JM
Choi
Sang Wook
SW
Han
Nam Ik
NI
Kim
Dong Goo
DG
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006510:Hepatitis B Antibodies / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D019259:Lamivudine