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Long‐term lamivudine monotherapy prevents development of hepatitis B virus infection in hepatitis B surface‐antigen negative liver transplant recipients from hepatitis B core‐antibody‐positive donors
Author(s) -
Prakoso Emilia,
Strasser Simone I.,
Koorey David J.,
Verran Deborah,
McCaughan Geoffrey W.
Publication year - 2006
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2006.00495.x
Subject(s) - lamivudine , medicine , hbsag , hepatitis b virus , liver transplantation , transplantation , hepatitis b , immunosuppression , immunology , gastroenterology , virus
Background: Liver transplantation from hepatitis B core‐antibody (HBcAb)‐positive donors to hepatitis B surface‐antigen (HBsAg)‐negative recipients has been associated with a risk of hepatitis B virus (HBV) infection in the absence of antiviral prophylaxis. The aim of this study is to assess the efficacy of long‐term lamivudine monotherapy to prevent development of HBV infection in HBsAg‐negative recipients of liver allografts from HBcAb‐positive donors. Methods: From 315 cadaveric adult liver transplantations performed at our unit between July 1999 and March 2005, 18 recipients (5.7%) received liver allografts from HBcAb‐positive donors, 13 of whom were HBsAg‐negative pre‐transplantation. The recipients consisted of four females and 14 males, age range 28–65 yr (median 49.5 yr). Post‐transplantation, HBsAg‐negative recipients were administered lamivudine 100 mg daily long term. HBsAg‐positive recipients were administered low‐dose hepatitis B immunoglobulin (HBIg) and lamivudine according to our usual protocol. Standard post‐transplantation immunosuppression was given. Recipients were followed up regularly (range 2–69 months, median 21 months) for development of de novo HBV infection. Results: Ten HBsAg‐negative recipients received long‐term lamivudine. One patient (HBcAb and HBsAb positive pre‐transplant) did not receive lamivudine and, in two patients, lamivudine was discontinued following urgent re‐transplantation for primary graft non‐function. All 13 of the HBsAg‐negative recipients were still alive, with no evidence of HBV infection at the end of follow‐up. Conclusion: Long‐term lamivudine monotherapy was effective in preventing development of HBV infection in HBsAg‐negative liver transplant recipients from HBcAb‐positive donors.