Prevention of hepatitis B recurrence after liver transplantation using lamivudine and hepatitis B immune globulin.

BACKGROUND

Patients undergoing liver transplantation (ltx) for hepatitis B-related liver disease are prone to recurrence. Historically, ltx has been associated with aggressive reinfection and poor survival results. The mainstay of prophylaxis has been passive immunotherapy with hepatitis B immune globulin(HBIG). Antiviral prophylaxis with lamivudine appears to reduce hepatitis B virus (HBV)infection after liver transplantation. However, HBV recurrence remains common. This study retrospectively evaluated a single center's experience with cohort of patients who underwent ltx for HBV-related chronic and acute liver disease. We examined the effect of a combined of intravenous HBIG and lamivudine viral prophylactic therapy on HBV recurrence and the outcome of ltx.

MATERIAL/

METHODS

Eighteen patients underwent transplantation for HBV liver disease at our center. Before ltx all patients were HBsAg positive and 3 were HBV DNA positive. HBV recurrence was defined by HBsAg seropositivity after ltx. HBIG monotherapy was used in 2 (15%) patients, lamivudine monotherapy in 4 (31%), and lamivudine and HBIG combination in 7 (54%). Hepatocellular carcinoma was present in 1 patients. Maintenance immunosuppression regimens consisted of either a cyclosporine- or tacrolimus-based drug regimen.

RESULTS

Overall 1-year and 3-years patient survival rates were 60% and 60%, respectively, and 1-year and 3-years graft survival was 60% and 60% respectively. Among 7 patients receiving receiving combination HBIG and lamivudine, one patient died. He was retransplanted 9 months after first transplantation secondary to biliary complication caused by late hepatic artery thrombosis. Of the 6 surviving patients, 4 patients currently have normal allograft function. Allograft dysfunction developed in two patients because of ischemic biliary strictures. Among seven patients, who received HBIG and lamivudine, one did not receive proper administration of the prophylactic regimen and graft became infected. Serologic HBV recurrence was diagnosed after 9 months after transplantation.

CONCLUSIONS

Liver transplantation for HBV under combination viral prophylaxis results in good survival rates. A good outcome is possible after liver transplantation for HBV liver disease using HBIG dosed by pharmacokinetic parameters in combination with lamivudine. Viral prophylactic therapy has effectively reduced HBV recurrence and prolonged survival outcome.