LAMIVUDINE PROPHYLAXIS AGAINST REINFECTION IN LIVER-TRANSPLANTATION FOR HEPATITIS-B CIRRHOSIS

Background Orthotopic liver transplantation in patients positive for h epatitis B virus (HBV) DNA is associated with a high reinfection rate, even with hepatitis B immunoglobulin (HBIG) prophylaxis. Nucleoside a nalogues that inhibit hepatitis B replication in patients with chronic hepatitis B could prevent reinfection after transplantation. The aim of this study was to analyse the efficacy and safety of prophylaxis bo th before and after transplantation with the nucleoside analogue lamiv udine, without HBIG, in patients undergoing liver transplantation. Met hods 17 HBsAg-positive patients with decompensated cirrhosis and previ ous evidence of viral replication were enrolled. 12 were HBV-DNA-posit ive by a signal amplification assay. Patients were treated with oral l amivudine (100 mg daily) for at least 4 weeks before transplantation a nd followed up for 18-90 weeks after transplantation. Findings HBV DNA became undetectable in serum before transplantation in all HBV-DNA-po sitive patients. Four died before transplantation from complications o f cirrhosis; one patient was withdrawn from the study because of a cer ebrovascular accident. The remaining 12 patients underwent transplanta tion. Two patients died after transplantation (one at 3 days and one [ suicide] at 20 weeks). HBV DNA reappeared in one patient with histolog ical evidence of recurrent hepatitis (72 weeks). By week 24 the nine r emaining patients had lost HBsAg and remained negative for HBV DNA. In terpretation Lamivudine treatment may prove useful in preventing recur rence of hepatitis B after liver transplantation. The effect on surviv al of patients after transplantation remains to be assessed.