Lamivudine After Hepatitis B Immune Globulin Is Effective in Preventing Hepatitis B Recurrence After Liver Transplantation |
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| Institution: | 1. Division of Infectious Disease, Children''s Memorial Hospital, Chicago, Illinois 60614, U.S.A.;2. Department of Pediatrics, Northwestern University Medical School, and Division of Infectious Disease Children''s Memorial Hospital, Chicago, United States;3. Departments of Internal Medicine and Paediatrics, Ciutat Sanitaria \"Vall d''Hebron\", Universidad Autónoma, Barcelona, Spain;2. University Department of Paediatrics, Singapore General Hospital, Kandang Kerbau Hospital, Singapore;4. University Department of Obstetrics and Gynaecology Singapore General Hospital, Kandang Kerbau Hospital, Singapore;5. University Department of Social Medicine and Public Health, Singapore General Hospital, Kandang Kerbau Hospital, Singapore;3. Ministry of the Environment, Singapore;1. Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, The Netherlands;2. Department of Immunohaematology and Blood Bank, University Hospital Leiden, The Netherlands;3. Department of Virology, Erasmus University, Rotterdam, The Netherlands;1. Department of Medicine B, Rambam Medical Center and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel;2. Department of Virology and Microbiology, Rambam Medical Center and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel |
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| Abstract: | The prevention of recurrent hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT) with hepatitis B immunoglobulin (HBIG) is expensive and requires indefinite parenteral administration. Lamivudine is a nucleoside analogue capable of inhibiting HBV replication. The aim of this study is to determine the efficacy of lamivudine in the prevention of recurrent HBV infection after a course of HBIG in patients who were hepatitis B surface antigen (HBsAg) positive and hepatitis Be antigen (HBeAg) negative before OLT. Patients at high risk for recurrent HBV infection (HBeAg positive and HBV DNA positive) were excluded. Thirty HBsAg-positive, HBeAg-negative patients underwent OLT from January 1993 to June 1997. All 30 patients were administered HBIG after OLT and, after 2 years, were given the option of continuing with HBIG or switching to lamivudine. Five patients were excluded: 3 patients were lost to follow-up and 2 patients died of technical complications. Three patients terminated HBIG therapy at 8, 24, and 29 months after OLT, and reinfection with HBV occurred in 1 patient. Six patients elected to continue HBIG therapy for life; 1 patient died of melanoma and the remaining 5 patients are HBsAg negative, with an average follow-up of 73 months. Sixteen patients were converted to lamivudine after a course of HBIG, and all 16 patients are HBsAg negative, with an average follow-up of 51 months after OLT. Five patients have been on lamivudine monotherapy for more than 24 months. These results suggest that lamivudine administered after a posttransplantation course of HBIG can effectively prevent the recurrence of HBV infection in patients who are HBsAg positive and HBeAg negative before OLT. (Liver Transpl 2000;6:434-439.) |
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