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

Abstract

PURPOSE: We studied the efficacy and safety of a nucleoside analogue lamivudine in prophylaxis against recurrent hepatitis B (HBV) in Asian patients after liver transplantation (LTx). METHODS: From September 1995 to September 1998, 27 Asian patients (age 17-60yr; M:F, 24:3) who were positive for HBsAg from chronic HBV underwent primary LTx using lamivudine prophylaxis. Ten (37%) patients were of UNOS status 1 and 6 (22%) had associated hepatocellular carcinoma. Fifteen patients received oral lamivudine (100 mg daily) for > 30 days (median, 90 days; 54-374 days) before LTx and 12 underwent LTx within 7 days (median, 4 days; 1-7 days) of lamivudine treatment. Sixteen patients were HBeAg-positive and 9 HBVDNA-positive (Quantiplex™ bDNA assay, Chiron Diagnostics) before lamivudine treatment. Six of 16 patients cleared HBeAg and 5 of 9 cleared HBVDNA before LTx. Lamivudine prophylaxis was continued after LTx and Hepatitis B immunoglobulin was not used. RESULTS: Five patients died of causes not related to HBV at 5 to 36 days after OLT. The remaining 22 (82%) patients were followed-up for a median of 15 months (4 to 39 months) after LTX. There was no adverse effect attributed to lamivudine. In 7 patients, HBsAg persisted or reappeared after a period of temporary clearance, and 15 patients remained HbsAg-negative at a median of 17 months after LTx. One (4.5%) patient developed recurrent hepatitis due to a mutant strain at the YMDD locus 397 days after LTx. There was no biochemical or histologic evidence of recurrent hepatitis B in the remaining 21 patients and none had detectable HBVDNA (by PCR) in serum at a median of 17 months (4 to 39 months) after LTx. CONCLUSIONS: At a median follow-up of 15 months, Lamivudine monotherapy is safe and effective in preventing recurrent hepatitis B following LTx in Asians.