Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin

Jay S. Markowitz, Paul Martin, Andrew J. Conrad, James F. Markmann, Philip Seu, Hasan Yersiz, John A. Goss, Peter Schmidt, Anita Pakrasi, Lucy Artinian, Natalie G.B. Murray, David K. Imagawa, Curtis Holt, Leonard I. Goldstein, Risë Stribling, Ronald W. Busuttil

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Abstract

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/JHBIG prophylaxis has not been reported. Fourteen patients underwent transplantation for decompensated liver disease owing to hepatitis B. Lamivudine (50 mg po/d) was begun before transplantation in 0 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% (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; 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.

Original languageEnglish (US)
Pages (from-to)585-589
Number of pages5
JournalHepatology
Volume28
Issue number2
DOIs
StatePublished - Aug 17 1998
Externally publishedYes

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ASJC Scopus subject areas

  • Hepatology

Cite this

Markowitz, J. S., Martin, P., Conrad, A. J., Markmann, J. F., Seu, P., Yersiz, H., Goss, J. A., Schmidt, P., Pakrasi, A., Artinian, L., Murray, N. G. B., Imagawa, D. K., Holt, C., Goldstein, L. I., Stribling, R., & Busuttil, R. W. (1998). Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin. Hepatology, 28(2), 585-589. https://doi.org/10.1002/hep.510280241