Lamivudine treatment for acute hepatitis B after liver transplantation

Background/Aims: Acute hepatitis caused by recurrent or de novo hepatitis B virus (HBV) infection after liver transplantation frequently induces aggre ssive disease leading to liver failure. The aim of this study was to determ ine the efficacy and safety of lamivudine treatment in post-transplant acut e hepatitis B. Method: Twelve patients with acute hepatitis B were started on lamivudine 1 00 mg po daily within 8 weeks of the appearance of HBsAg, One patient was e xcluded after 1 month because of hepatocellular carcinoma recurrence. Patie nts were followed for an average of 68.6 weeks (range 32-108), and were cli nically and biochemically evaluated on a monthly basis, They had a histolog ical assessment at baseline, after at least 6 months, and whenever clinical ly indicated. Results: Basal HBV-DNA ranged between 13 and 1288 pg/ml and serum alanine a minotransferase between 97 and 1036 U/l, HBV-DNA became undetectable within 8 weeks and transaminases normalized within 24 weeks in all cases, At the last visit, eight patients (73%) remained HBV-DNA negative by liquid hybrid ization and had normal or close to normal alanine aminotransferase, Five pa tients (45%) were also HBsAg negative and HBV-DNA negative by polymerase ch ain reaction. HBV-DNA and transaminase breakthrough occurred in three patie nts (27%). Histology after 6-9 months showed chronic hepatitis in seven pat ients. Lamivudine was well tolerated without serious adverse reactions. Conclusions: These results indicate that lamivudine treatment induces susta ined inhibition of viral replication and normalization of transaminases in the majority of post-transplant patients with acute hepatitis B. HBsAg loss may be achieved in a considerable number of cases, Although viral resistan ce is relatively frequent, early initiation of lamivudine appears to be eff ective and safe.