Efficacy of lamivudine for the treatment of hepatitis B virus infection after liver transplantation in children

Background. There is at present very little information about hepatitis B v irus (HBV) infection in children after liver transplantation. This is the f irst study to assess the safety and efficacy of lamivudine in this patient population. Methods. We describe three children aged 5-14 years who underwent liver tra nsplantation for fulminant hepatitis A, hyperoxaluria, and cystic fibrosis. Despite adequate immunoprophylaxis, two of the children who were serum hep atitis B surface antigen-positive before transplantation (HBV DNA-negative by hybridization) had a reactivation of the disease, and one had a de novo HBV infection, at 12-18 months after transplantation. Lamivudine 3 mg/kg wa s administered on a compassionate-use basis for 14-36 months. Results. After 1 month of therapy, HBV DNA disappeared from the serum in al l patients by hybridization and in two patients by polymerase chain reactio n. In all three children, alanine transaminase levels normalized. One child developed lamivudine resistance after 22 months with no evidence of hepati c decompensation. Repeated liver histological studies revealed progression of hepatic fibrosis in one child. All children remained serum hepatitis B s urface antigen-and hepatitis B e antigen-positive. No adverse effects of th e drug were noted. Conclusion. Lamivudine is beneficial and well tolerated in children with HB V infection after liver transplantation.