Outcome of liver transplantation for hepatitis B: Report of a single center's experience

Results of liver transplantation (LT) for hepatitis B have improved significantly with the use of hepatitis B immune globulin (HBIG) and/or lamivudine. The aim of this study is to review the long‐term outcome of patients who underwent LT for hepatitis B. Records of 41 patients who underwent LT for hepatitis B and survived 3 months or longer post‐LT were reviewed. Twenty patients were administered no immunoprophylaxis or short‐term intramuscular HBIG, whereas 21 patients were administered high‐dose intravenous (IV) HBIG. Median post‐LT follow‐up in these 2 groups was 76 months (range, 4 to 155 months) and 25 months (range, 4 to 68 months), respectively. Hepatitis B recurred in 15 (75%) and 4 patients (19%) who underwent LT in the pre‐HBIG and post‐HBIG eras, respectively. Cumulative rates of recurrent hepatitis B at 1 and 3 years post‐LT in these 2 groups were 66% and 77% and 20% and 20%, respectively ( P < .001). Recurrent hepatitis B in the post‐HBIG era correlated with antibody to hepatitis B surface antigen titer less than 100 IU/L. Nine patients with recurrent hepatitis B were administered lamivudine for 13 to 49 months (median, 28 months); 6 patients continued to have stable or improved liver disease, whereas 3 patients developed virological breakthrough with slow deterioration of liver disease. Long‐term IV HBIG is effective in preventing recurrent hepatitis B. The risk for recurrent hepatitis B is negligible after the first year post‐LT. Among patients with no virological breakthrough, lamivudine can stabilize or improve liver disease for up to 4 years in patients with recurrent hepatitis B post‐LT.