PROSTAGLANDIN-E IN THE TREATMENT OF RECURRENT HEPATITIS-B INFECTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

While orthotopic liver transplantation (OLT) has become the treatment of choice for most irreversible end-stage liver diseases, its role in patients with hepatitis B (HBV) infection is controversial. A high ris k of reinfection of the transplanted graft, associated with significan t morbidity and mortality, has been reported. Although passive and act ive immunization can delay reappearance of the virus in the allograft, there is not yet an effective therapy for recurrent HBV infection in liver transplant recipients. Between October 1985 and March 25, 1991, 28 OLT in 25 patients with acute and chronic HBV infections were perfo rmed. Twelve of the patients were HBV DNA-negative, six were HBV DNA-p ositive, and seven were not tested prior to transplantation. Only the 19 patients surviving more than 100 days after transplantation were co nsidered to have sufficient duration of follow-up (mean 734 days; rang e 500-1545) to include in analysis of recurrence. Five (26%) were free of recurrent disease at the time of last follow-up (mean 1031 days, r ange 526 to 1770 days. Recurrent HBV in the allograft, as defined by p ositive immunoperoxidase stains of biopsy sections for viral antigens, was detected in 74% (13 male, 1 female; 7 Asian, 7 white) at a mean o f 134 days posttransplantation. Histological changes of viral hepatiti s, first appearing an average of 157 days (range 95-326) posttransplan tation, were evident in 13 of 14 with positive immunostaining. Twelve of the 14 patients were treated, on an open trial basis, with intraven ous and oral prostaglandin E (PGE) because of deteriorating clinical c ondition. Eleven of the twelve responded to PGE with an initial drop i n serum transaminases, improvement in coagulopathy and resolution of e ncephalopathy. One patient failed to respond and died of a myocardial infarction within 9 days of institution of therapy. Three of the eleve n patients with an initial response relapsed and died in liver failure as a direct result of recurrent HBV after 13, 16, and 37 days of trea tment in association with generalized sepsis. Eight of the 12 patients (67%) had a sustained favorable response to PGE therapy (mean follow- up 737 days, range 403-1545). All patients with a sustained response h ad accompanying improvement in histology and reduction in viral antige n staining in hepatocytes. Treatment with PGE appeared to be of benefi t in recurrent HBV infection of the transplanted liver with an initial response rate of 92% and a sustained response rate of 67%.