RECURRENCE OF HEPATITIS-B IN LIVER-TRANSPLANTS TREATED WITH ANTIVIRALTHERAPY

Background and Aims. In patients with terminal Hepatitis B Virus-relat ed liver diseases, liver transplantation carries a consistent risk of Hepatitis B Virus recrudescence in the graft. In the attempt to reduce the reinfection rare with antiviral therapy, we studied a total of 16 viraemic patients. Patients and Methods, Twelve patients received Gan ciclovir; starting 4-67 days (mean 25 days) before transplantation and prolonged for 10 days after transplantation; four patients were treat ed with Lactosaminated Arabinoside-Monophosphate 6 hours before surger y and prolonged for 28 days after surgery. All received hepatitis B im munoglobulins. Results. At transplantation, HBV-DNA had decreased to a bout 10(4) virus/ml (as assessed by the polymerase chain reaction assa y) in 10 of the 12 patients treated with Ganciclovir. Of these patient s, 4 died perioperatively from causes unrelated to Hepatitis B Virus r einfection. Of the eight survivors, only the patient who maintained a titre of 10(6) virus/ml at the time of transplantation developed viral recurrence 4 months after surgery. Before transplantation, 2 of the p atients treated with Lactosaminated Arabinoside-Monophosphate had a vi raemic load of 10(6) and 2 of 10(4) virus/ml. In all cases, viraemia b ecame undetectable at the end of therapy. None died and Hepatitis B Vi rus recurred 2 months after transplantation in one. The overall rare o f Hepatitis B Virus recurrence was 16.6%. The recurrence rate decrease d to 9% in patients in whom the viraemic load decreased to around 10(4 ) virus/ml following treatment, compared to an overall recurrence rate of 50% in our historical series of patients transplanted for Hepatiti s B Virus-related cirrhosis. Conclusion, Antiviral therapy was effecti ve in decreasing the risk of Hepatitis B Virus reinfection of the live r graft by decreasing the viral load before surgery.