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Hepatology 1998 Aug;28(2):585-589
Prophylaxis against Hepatitis B recurrence following liver
transplantation using combination lamivudine and Hepatitis B immune globulin.
Markowitz JS, Martin P, Conrad AJ, Markmann JF, Seu P, Yersiz H, Goss JA, Schmidt
P, Pakrasi A, Artinian L, Murray NG, Imagawa DK, Holt C, Goldstein LI, Stribling
R, Busuttil RW
The Dumont-UCLA Transplant Center and the Division of Liver and Pancreas Transplantation,
UCLA Medical Center, Los Angeles, CA 90095, USA.
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 p.o./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.
PMID: 9696028, UI: 98359199
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