Successful orthotopic liver transplantation for lamivudine-associated YMDDmutant hepatitis B virus

YMDD hepatitis B virus (HBV) mutants emerge in more than one third of patie nts treated with lamivudine, The development of escape mutants potentially limits the efficacy of this new therapy for chronic HBV infection. Transpla nt centers may be hesitant to perform orthotopic liver transplantation (OLT ) in patients with progressive liver disease who develop the YMDD mutant be cause of concerns of graft reinfection. We describe a 56-year-old man with chronic liver disease caused by HBV who successfully underwent OLT after th e emergence of a YMDD mutant and progressive liver disease, Perioperatively , he received high-dose intravenous hepatitis B immune globulin (HBIG) trea tment with continued lamivudine treatment, Thirty-two months after OLT, the re was no evidence of HBV reinfection with the use of lamivudine and high-d ose HBIG. Our experience suggests that the emergence of a YMDD HBV mutant i s not a contraindication to OLT, The combination of lamivudine and high-dos e HBIG can protect against reinfection of the hepatic allograft with the YM DD HBV escape mutant.