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Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin
Author(s) -
Markowitz Jay S.,
Martin Paul,
Conrad Andrew J.,
Markmann James F.,
Seu Philip,
Yersiz Hasan,
Goss John A.,
Schmidt Peter,
Pakrasi Anita,
Artinian Lucy,
Murray Natalie G.,
Imagawa David K.,
Holt Curtis,
Goldstein Leonard I.,
Stribling Risë,
Busuttil Ronald W.
Publication year - 1998
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510280241
Subject(s) - lamivudine , hepatitis b immune globulin , medicine , transplantation , hepatitis b virus , liver transplantation , hepatitis b , hbsag , gastroenterology , liver disease , immunology , virus
Patients undergoing liver transplantation for hepatitis B–related liver disease are prone to recurrence. The mainstay of prophylaxis has been passive immunotherapy with hepatitis B immune globulin (HBIG). Antiviral therapy with lamivudine has proven effective in lowering hepatitis B virus (HBV) DNA and improving histology in patients with hepatitis B infection; its role in prophylaxis against hepatitis B recurrence following liver transplantation is under investigation. Viral breakthrough and resistance, however, are a significant problem with monotherapy with either HBIG or lamivudine. The efficacy of combination lamivudine/HBIG prophylaxis has not been reported. Fourteen patients underwent transplantation for decompensated liver disease owing to hepatitis B. Lamivudine (150 mg po/d) was begun before transplantation in 10 patients, including 4 who were HBV DNA–positive. In addition, 1 patient was HBV DNA–positive when transplanted. HBIG was given perioperatively and continued thereafter; treatment with lamivudine was maintained or initiated at the time of transplantation and continued indefinitely. The median follow‐up was 387 days. Actuarial 1‐year patient and graft survival was 93% (1 patient died of unrelated causes). At a median interval of 28 days following lamivudine treatment, all 5 HBV DNA–positive patients cleared HBV DNA from the serum; 1 went on to clear hepatitis B surface antigen (HBsAg), before transplantation, at day 148 of lamivudine treatment. By the highly sensitive polymerase chain reaction (PCR), at a median of 346 days (range, 130‐525 days) following transplantation, all 13 surviving patients had no detectable serum HBV DNA. Lamivudine suppresses HBV replication in patients awaiting liver transplantation. At a median follow‐up of 1.1 years, combination prophylaxis with lamivudine and HBIG prevented hepatitis B recurrence following liver transplantation.