Liver transplantation in Asian patients with chronic hepatitis B using lamivudine prophylaxis

Objective To report the results of liver transplantation in 31 Asian patien ts with chronic hepatitis B using lamivudine prophylaxis in an open-label s tudy. Summary Background Data Chronic hepatitis B is a prevalent cause of end-sta ge liver disease in Asia, but the results of liver transplantation in these patients are poor. Methods Thirty-one Asian patients with chronic hepatitis B underwent liver transplantation using lamivudine prophylaxis (100 mg daily). Twenty-three ( 74%) patients had detectable serum hepatitis B envelope antigen (n = 18) or hepatitis B virus DNA (n = 11) before treatment, and seven had associated hepatocellular carcinoma. Lamivudine was continued indefinitely after trans plantation, and hepatitis B immune globulin was not used. Results The actuarial patient and graft survival rates were 84% and 81%, re spectively. Five patients died of causes unrelated to hepatitis B, and 26 p atients were alive at a median follow-up of 16 months (range 6-47) after tr ansplantation. One (3.8%) patient developed recurrent hepatitis B resulting from viral breakthrough at week 53 and survived after retransplantation us ing adefovir and hepatitis B immune globulin treatment. The remaining 25 su rviving patients had no biochemical or histologic evidence of recurrent hep atitis, and serum hepatitis B virus DNA remained negative by polymerase cha in reaction. In six patients, hepatitis B surface antigen (HBsAg) persisted or reappeared in serum. Among 19 patients who became negative for HBsAg fr om 5 to 431 days after transplantation, 13 developed anti-HBsAb that lasted a median of 6 months (range 1-21). None of the seven patients with hepatoc ellular carcinoma developed recurrent tumor. Conclusions Asian patients with chronic hepatitis B may achieve a good outc ome after liver transplantation using lamivudine prophylaxis.