EFFICACY OF LAMIVUDINE IN CHRONIC HEPATITIS-B PATIENTS WITH ACTIVE VIRAL REPLICATION AND DECOMPENSATED CIRRHOSIS UNDERGOING LIVER-TRANSPLANTATION

Liver transplantation for endstage hepatitis B virus (HBV) infection h as been associated with survival inferior to that of liver transplanta tion in other chronic liver diseases due to HBV reinfection of the gra ft, Lamivudine is a new nucleoside analog with potent antiviral effect s against hepatitis B. Our aim was to test its efficacy when used pre- and posttransplantation in HBV-DNA positive patients with endstage fi ver disease, Patients received oral lamivudine 100 mg daily both pretr ansplant and posttransplant. Viral serology, serum and tissue HBV-DNA and liver histology were assessed sequentially, Five consecutive patie nts with endstage hepatitis B were entered into the trial. Serum HBV-D NA was cleared pretransplant in all patients, Three of four transplant ed patients cleared HBeAg and HBsAg postoperatively, whereas all four became negative for serum HBV-DNA (dot-blot and PCR). Liver biopsies w ere negative for HBV-DNA by PCR in 3 of 4 cases, Lymphocytes were nega tive for HBV-DNA by PCR in all cases, With follow-up of 3, 14, 16, and 26 months, two patients have normal liver enzymes and normal liver hi stology and two have developed recurrent hepatitis B. No significant s ide effects were seen. This pilot study shows that lamivudine can effe ctively inhibit hepatitis B virus in cirrhotic patients pretransplant and posttransplant. A lamivudine resistant mutant developed in two pat ients. Transplant recipients with actively replicating HBV related cir rhosis may achieve a good outcome after liver transplantation using la mivudine, but viral resistance is likely to be a significant problem.