Elsevier

Transplantation Proceedings

Volume 45, Issue 6, July–August 2013, Pages 2326-2330
Transplantation Proceedings

Emerging trends in transplantation
Liver transplantation
Hepatitis B Prophylaxis Using Lamivudine and Individualized Low-dose Hepatitis B Immunoglobulin in Living Donor Liver Transplantation

https://doi.org/10.1016/j.transproceed.2013.03.028Get rights and content

Abstract

Background

Currently, most available experience concerning prophylaxis against hepatitis B virus (HBV) recurrence after living donor liver transplantation (LDLT) is limited to studies of small size and short follow-up. The objective of this study was to evaluate the efficacy of a prophylactic regimen using lamivudine and individualized low-dose intramuscular hepatitis B immunoglobulin (HBIG) in LDLT.

Methods

We used a database of adult-to-adult right-lobe LDLT procedures performed from June 2002 to April 2012 at our center for HBV-related end-stage liver diseases. Patients were divided into 3 groups: group A, HBV-related decompensated liver cirrhosis; group B, fulminant hepatitis B; and group C, hepatocellular carcinoma (HCC).

Results

During a mean follow-up of 38.3 ± 28.9 months, 8 of 165 (4.8%) recipients developed HBV recurrences. The mean time for HBV reinfection was 15.8 + 11.0 months after transplantation. The overall 1-, 3-, and 5-year HBV recurrence rates were 3%, 7%, and 8.2%, respectively. Both patients with fulminant hepatitis B or HCC seemed to have higher rates of HBV recurrence than those with decompensated liver cirrhosis, albeit not significantly. The independent predictor of HBV recurrence was high HBV DNA level (≥105 copies/mL) at LDLT.

Conclusions

Lamivudine and individualized low-dose intramuscular HBIG provides effective prophylaxis against HBV recurrence after LDLT. Pre-LDLT HBV DNA of ≥ 105 copies/mL was associated with HBV recurrence.

Section snippets

Patients

We used a database of adult-to-adult right-lobe LDLT procedures performed at our center from June 2002 to April 2012 for HBV-related ESLDs, including decompensated liver cirrhosis, fulminant hepatitis B, and HCC, for this analysis. Enrolled patients had no evidence of coinfection with hepatitis C, hepatitis D, or human immunodeficiency virus. Finally, a total of 165 adult patients were enrolled in this study. The patients were monitored until July 2012 or their death, and their medical records

Characteristics of Recipients and Their Donors

Table 1 summarizes the recipients' data at the time of transplantation. Patients in group C were older than those in groups A and B, whereas patients in group B had the highest mean model for end-stage liver disease score, followed by groups A and C. Among the patients with HCC, 41 (43.6%) had tumors within the Milan criteria, 59 (62.8%) had tumors within the University of California, San Francisco (UCSF) criteria, and 35 (37.2%) had tumors exceeding the UCSF criteria. Other data shown in the

Discussion

To date, most available studies concerning prophylaxis against HBV recurrence after LDLT are limited, of small size, and have a short follow-up time.3 To the best of our knowledge, one representative research with the largest sample size and longest follow-up time was from Hwang et al,4 in which the high-dose HBIG monotherapy resulted in a 10-year HBV recurrence rate of 7.3%. However, this protocol could not be replicated in mainland China because of the unavailability of intravascular HBIG and

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Cited by (11)

  • Antiviral Combination Therapy with Low-Dose Hepatitis B Immunoglobulin for the Prevention of Hepatitis B Virus Recurrence in Liver Transplant Recipients: A Single-Center Experience

    2015, Transplantation Proceedings
    Citation Excerpt :

    In the light of these limitations, decreasing the dose of HBIG as prophylaxis has been of particular interest. Early studies have reported similar results compared with that of previous dosages [10–12]. HBIG in combination with antivirals such as lamivudine as a therapeutic protocol has not been well embraced because of lamivudine-related resistance.

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Supported by a grant from the National Natural Science Foundation of China (81170456).

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