Lamivudine after hepatitis B immune globulin is effective in preventing hepatitis B recurrence after liver transplantation

The prevention of recurrent hepatitis B virus (HBV) infection after orthoto pic liver transplantation (OLT) with hepatitis B immunoglobulin (HBIG) is e xpensive and requires indefinite parenteral administration. Lamivudine is a nucleoside analogue capable of inhibiting HBV replication. The aim of this study is to determine the efficacy of lamivudine in the prevention of recu rrent HBV infection after a course of HBIG in patients who were hepatitis B surface antigen (HBsAg) positive and hepatitis Be antigen (HBeAg) negative before OLT. Patients at high risk for recurrent HBV infection (HBeAg posit ive and HBV DNA positive) were excluded. Thirty HBsAg-positive, HBeAg-negat ive patients underwent OLT from January 1993 to June 1997, All 30 patients were administered HBIG after OLT and, after 2 years, were given the option of continuing with HBIG or switching to lamivudine. Five patients were excl uded: 3 patients were lost to follow-up and 2 patients died of technical co mplications. Three patients terminated HBIG therapy at 8, 24, and 29 months after OLT, and reinfection with HBV occurred in 1 patient. Six patients el ected to continue HBIG therapy for life; 1 patient died of melanoma and the remaining 5 patients are HBsAg negative, with an average follow-up of 73 m onths. Sixteen patients were converted to lamivudine after a course of HBIG , and all 16 patients are HBsAg negative, with an average follow-up of 51 m onths after OLT, Five patients have been on lamivudine monotherapy for more than 24 months. These results suggest that lamivudine administered after a posttransplantation course of HBIG can effectively prevent the recurrence of HBV infection in patients who are HBsAg positive and HBeAg negative befo re OLT.