Role of long-term lamivudine treatment of hepatitis B virus recurrence after liver transplantation

Authors

  • Hyun Young Woo,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Jong Young Choi,

    Corresponding author
    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
    • Associate Professor, Liver Transplantation Clinic, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, #505 Banpodong, Seocho-ku, Seoul 137-040, Korea.
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  • Jeong Won Jang,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Chan Ran You,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Si Hyun Bae,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Seung Kew Yoon,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Jin Mo Yang,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Sang Wook Choi,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Nam Ik Han,

    1. Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Dong Goo Kim

    1. Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Abstract

In this study, the long-term (>3 years) efficacy of combination therapy for hepatitis B virus (HBV) recurrence and the associated factors were investigated. One hundred and sixty-five consecutive HBsAg-positive patients (92 with liver cirrhosis, 73 with hepatocellular carcinoma; HCC) who underwent liver transplantation were assessed with a median follow-up time of 40 months. One hundred and twenty-one patients (121/165, 73.3%) were treated with lamivudine before transplantation for a mean of 8.4 months (range 0.1–72 months). The post-transplantation treatment protocol consisted of a high dose intravenous hepatitis B immunoglobulin (HBIg) followed by a low dose intramuscular HBIg and lamivudine combination therapy. Seven (4.2%, 7/165) recipients experienced HBV recurrence at a median time of 19 months (range 5–36 months) following transplantation. Six of seven cases of HBV recurrence were treated with lamivudine before transplantation for a median period of 15 months (range 0.6–30 months). Eighteen (24.6%, 18/73) patients had HCC recurrences after transplantation. Of the four patients with both HCC and HBV recurrence, three experienced HBV recurrence after recurrence of HCC. The clinical factor associated with HBV recurrence in the total cohort (n = 165) was the duration of antiviral treatment (over 6 months) before transplantation (P = 0.004). In the HCC group, HCC recurrence after transplantation (P= 0.002), tumor burden before transplantation (P = 0.005), and postoperative adjuvant chemotherapy (P = 0.002), were additional factors for HBV recurrence. Combination therapy of HBIg and antiviral drugs was effective over 3 years regardless of the pretransplantation viral load. However, the possible recurrence of HBV needs to be monitored cautiously in patients treated with long-term (over 6 months) lamivudine. J. Med. Virol. 80:1891–1899, 2008. © 2008 Wiley-Liss, Inc.

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