EFFICACY OF LAMIVUDINE IN CONTROLLING HEPATITIS-B VIRUS RECURRENCE AFTER LIVER-TRANSPLANTATION

Background. Indication of liver transplantation for patients infected with hepatitis B virus (HBV) remains controversial because of the high incidence of posttransplant HBV recurrence and aggressive involvement of the allograft. In this article, we provide evidence that the intro duction of lamivudine may favorably alter the prognosis of these patie nts. Methods. Lamivudine was used in 40 HBV-infected adult patients su ffering from chronic end-stage liver disease who underwent liver trans plantation. The drug was used in the following settings: failure of pr olonged passive immunoprophylaxis, elective conversion from immunoprop hylaxis, de novo posttransplant HBV infection, and primary treatment w ith lamivudine which started before and continued after transplantatio n. Twenty patients (50%) had viral replication at the time lamivudine was started. Posttransplant and antiviral treatment follow-ups were 8- 64 months (median follow-up: 27.5 months) and 9-39 months (median foll ow-up: 19 months), respectively. Results. The patient and graft surviv al rates were 97.5% (39/40). Thirty-three patients (82.5%) have remain ed free of viral recurrence. In the seven re-infected patients, the ma nifestations of HBV involvement of the allograft have been mild. There have been no side effects related to lamivudine, and the treatment is substantially less costly than with other anti-HBV agents. Conclusion s. Compared with historic series utilizing other modalities of treatme nt, the use of lamivudine has, so far, yielded superior results. This drug may be an important acquisition for antiviral prophylaxis in HBV- infected liver recipients. Because of the risk of viral mutations, how ever, efforts should proceed to achieve more efficacious methods for p revention and control of HBV recurrence.