PRETRANSPLANT FAMCICLOVIR AS PROPHYLAXIS FOR HEPATITIS-B VIRUS RECURRENCE AFTER LIVER-TRANSPLANTATION

Liver transplantation in patients with detectable hepatitis B virus (H BV) DNA is associated with a high rate of HBV recurrence and detectabl e HBV DNA is often considered a contraindication for liver transplanta tion. Famciclovir, an oral form of the purine nucleoside penciclovir, has been shown to inhibit HBV replication. This pilot study was conduc ted to determine whether a 6-month course of famciclovir, administered before transplantation, was effective in inhibiting HBV replication i n patients with end-stage liver disease caused by HBV and detectable H BV DNA and to assess the posttransplant clinical and virologic out-com e of patients becoming HBV DNA negative with famciclovir prior to tran splantation. All eight patients enrolled with hepatitis B surface anti gen (HBsAg) positive; their HBV DNA levels at baseline ranged from 4.3 to 25,321 pg/ml (mean 3,661 pg/ml). Six of the eight patients were al so seropositive for HBeAg. An initial decline in HBV DNA titers occurr ed in all patients; however, only 25% (two of eight) of the patients b ecame HBV DNA negative before transplantation and underwent liver tran splantation. Seroconversion to hepatitis B surface antibody (HBsAb) (a nd HBeAb in HBeAg-positive patient) was demonstrated at the conclusion of famciclovir in the transplanted patients. Both patients remain HBV DNA negative at nearly 2 years of follow-up after transplantation. HB V DNA remained detectable in 63% (five of eight) of the patients. The mean HBV DNA level for patients who became HBV DNA negative was 5.1 pg /mI versus 424 pg/ml in nonresponders. Adverse effects attributable to famciclovir were not observed in any of the patients. Future studies should assess the predictors of response to famciclovir so that patien ts likely to achieve good virologic outcome can be targeted for such a therapy.