BENEFICIAL EFFECT OF LAMIVUDINE IN RECURRENT HEPATITIS-B AFTER LIVER-TRANSPLANTATION

Orthotopic liver transplantation (OLT) in patients infected with hepat itis B virus (HBV) is known to be associated with a high recurrence ra te and poor prognosis. Interferon treatment in these patients offers l ittle benefit and may lead to further complications. Lamivudine, the ( -)enantiomer of 3'-thiacytidine, a 2'3'-dideoxynucleoside, is known to be a potent inhibitor of HBV replication in patients with chronic HBV infection. Three HBV-positive OLT patients were administrated lamivud ine, 100 mg x 1 orally, for a period of at least 20 weeks, in an open, compassionate-use basis. All three patients were HBV DNA-negative bef ore OLT. HBV reinfection occurred at a median time of 7 months (range, 6-9 months) after OLT, in spite of adequate immunoprophylaxis. All th ree patients had high serum transaminase levels (alanine aminotransfer ase [ALT], 103-324 U/L) and histologic evidence of recurrent HBV infec tion of the grafted liver, and HBV DNA was evident in the sera of all of them. Six weeks after lamivudine treatment, HEV DNA disappeared fro m the serum of all patients (detected by hybridization); by the 10th w eek, HBV DNA was also negative by polymerase chain reaction in two out of three patients, Interestingly, the one patient who was HEV DNA pos itive by polymerase chain reaction still has mildly elevated ALT level s, whereas the other two patients have normal ALT levels. We also note d that on the 5th week there was a transient elevation of serum ALT le vels in two patients, No adverse effects or rejection episodes were no ted. In conclusion, lamivudine is a beneficial and well-tolerated ther apy in OLT patients with recurrent HBV infection, We are studying the effect of lamivudine in other patients and for a longer period of time .