title: Liver transplantation for hepatitis B-induced liver disease: long-term outcome and effectiveness of antiviral therapy for prevention of recurrent hepatitis B infection.
abstract: OBJECTIVE
  The aim of this study was to examine the efficacy of preoperative, perioperative, and long-term treatment in liver transplant (OLT) patients suffering hepatitis B (HBV)-induced liver disease, in terms of graft and survivals as well as disease recurrence.
  
  
  METHODS
  We reviewed the medical records of 19 HBV-infected patients who underwent OLT between 2000 and 2010 using antiviral treatment with either lamivudine (LAM, n = 14) and/or adefovir/entecavir/tenofovir (n = 8) before OLT. Fifteen subjects showed a HBV DNA-negative status prior to OLT. All patients were administered HBIG (antiHBs immunoglobulin) perioperatively: 10,000 international units (IU) in the anhepatic phase and 2.000 IU/d until day 7 after OLT. The preoperative antiviral regimen was continued as maintenance prophylaxis from day 1 after OLT. In cases of the YMMD mutation the antiviral treatment was switched to combination therapy with entecavir and tenofovir.
  
  
  RESULTS
  Patient follow-up as of December 2011 or till time of death ranged from 6 to 129 months (median = 47). All patients were prescribed tacrolimus. None of them experienced HBV-related graft dysfunction or graft loss. All subjects were HBV DNA negative at 6 months after OLT. HBV recurrence in the post-OLT phase was discovered in 3 patients, 2 of whom had undergone OLT because of acute liver failure due to hepatitis B. They showed LAM-resistant mutations at the time of recurrence and underwent entecavir/tenofovir therapy to achieve HBV DNA negative status.
  
  
  CONCLUSIONS
  Our study demonstrated excellent long-term outcomes among patients after successful preoperative antiviral treatment for HBV. Patients should be given a high dosage of HBIG during the first week after OLT in combination with the preoperatively established antiviral treatment. In presence of a LAM-resistance mutation, antiviral treatment should be adapted individually to achieve HBV recurrence freedom and graft survival.
authors.affiliation: Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany. aristotelis.perrakis@uk-erlangen.de
authors.forename: A
authors.initials: A
authors.lastname: Perrakis
authors.forename: T
authors.initials: T
authors.lastname: Förtsch
authors.forename: A
authors.initials: A
authors.lastname: Del Medico
authors.forename: R S
authors.initials: RS
authors.lastname: Croner
authors.forename: N
authors.initials: N
authors.lastname: Vassos
authors.forename: S
authors.initials: S
authors.lastname: Yedibela
authors.forename: C
authors.initials: C
authors.lastname: Lohmüller
authors.forename: S
authors.initials: S
authors.lastname: Zopf
authors.forename: W
authors.initials: W
authors.lastname: Hohenberger
authors.forename: V
authors.initials: V
authors.lastname: Müller
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery*; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral