Prevention of hepatitis B virus recurrence after liver transplantation in cirrhotic patients treated with lamivudine and passive immunoprophylaxis

Background/Aims: Treatment with hepatitis B virus immune globulins (HBIG) o r lamivudine has reduced the rate of hepatitis B recurrence after liver tra nsplantation to approximately 50%. Methods: To further decrease hepatitis B recurrence, 33 hepatitis B virus ( HBV)-related cirrhotic patients were treated with lamivudine before liver t ransplantation and with lamivudine together with low-dose HBIG (46 500 IU t he first month followed by 5000 IU/monthly) after surgery. Results: While on lamivudine, serum HBV DNA level decreased significantly i n all patients and in 11 (33%) the Child-Pugh score improved. Twenty-six pa tients were transplanted. Among the 25 who survived for longer than 12 mont hs, only one (4%) experienced a hepatitis B recurrence over an average foll ow-up of 31 months, a rate significantly lower (P = 0.0002) than the 50% re currence rate among a historical control group of 12 patients. However, low -level HBV replication was detected sporadically throughout the follow-up i n 64% of patients. Conclusions: Over the medium-term, combined prophylaxis with lamivudine and HBIG significantly decreases the risk of hepatitis B recurrence after live r transplantation. Though low-level HBV infection recurred in two thirds of patients, the pathogenic expression of HBV was prevented. (C) 2001 Europea n Association for the Study of the Liver. Published by Elsevier Science B.V . All rights reserved.