Lamivudine for hepatitis B in liver transplantation - A single-center experience

Background. Liver transplantation for hepatitis B virus (HBV) has been asso ciated with a high rate of reinfection and graft failure. Lamivudine, a pot ent inhibitor of HBV replication, has been shown to prevent viral recurrenc e after transplantation. Methods. The effectiveness of lamivudine monotherapy for the management of HBV recurrence after liver transplantation was assessed. Lamivudine was use d in three patient groups: (1) patients started before transplantation and continued after transplantation (n=13); (2) patients treated after transpla ntation (n=15); and (3) patients with de novo hepatitis B after transplanta tion (n=4). Results. Median follow-up on lamivudine was 24 months. Active viral, replic ation (HBV-DNA+) was seen in 17 (53%) of 32 at treatment initiation. All lo st HBV-DNA at a mean of 2.4+/-1.6 months after lamivudine initiation. Twent y-six (81%) patients remain free of viral recurrence. Six (19%) patients ha ve evidence of breakthrough infection with the YMDD mutant of HBV, two of w hom progressed to graft failure. All four patients in group 1 who developed breakthrough had evidence of hepatitis B surface antigen expression in the explanted liver by immunohistochemistry despite being serum HBV-DNA negati ve before transplantation. No difference was observed among the three group s in DNA clearance or breakthrough rates. Conclusions. Lamivudine achieves viral DNA clearance in almost all patients . Expression of viral antigens in the liver seems to identify patients at r isk of developing HBV-DNA recurrence. Disease-free survival of 81% at 22 mo nths is similar to data with hepatitis B immunoglobulin therapy, Given the safe clinical profile and high efficacy in the prevention of disease recurr ence, lamivudine win favorably change the outlook of liver transplantation for HBV.