Lamivudine treatment for hepatitis B reactivation in HBsAg carriers after organ transplantation: A 4-year experience
Article first published online: 12 JAN 2002
Journal of Gastroenterology and Hepatology
Volume 16, Issue 9, pages 1001–1008, September 2001
How to Cite
Liu, C.-J., Lai, M.-Y., Lee, P.-H., Chou, N.-K., Chu, S.-H., Chen, P.-J., Kao, J.-H., Jen, Y.-M. and Chen, D.-S. (2001), Lamivudine treatment for hepatitis B reactivation in HBsAg carriers after organ transplantation: A 4-year experience. Journal of Gastroenterology and Hepatology, 16: 1001–1008. doi: 10.1046/j.1440-1746.2001.02532.x
- Issue published online: 12 JAN 2002
- Article first published online: 12 JAN 2002
- hepatitis B surface antigen carrier;
- hepatitis C virus;
- organ transplantation;
Background: Reactivation of hepatitis B after organ transplantation in hepatitis B surface antigen (HBsAg) carriers may be fatal. In this study, we reported our experience of lamivudine treatment in HBsAg carriers who had post-transplant reactivation of hepatitis B.
Methods: The patients were 15 men and one woman. Nine received kidney transplants, six received heart transplants, and one received a lung transplant. They developed a reactivation of hepatitis B 1–101 months (median, 14 months) after transplantation. They received lamivudine 100 mg daily on a compassionate-use basis, and had regular follow ups. The median pretreatment total serum bilirubin level was 3.0 mg/dL, and the alanine aminotransferase level was 357 U/L. Four of the 16 patients were positive for HBeAg. The serum hepatitis B virus (HBV) DNA levels were > 3000 pg/mL in 13 (81%) patients. Three were coinfected with hepatitis C virus.
Results: The overall survival rate was 75%. All four fatal cases had a pretreatment total serum bilirubin level of ≥ 3 mg/dL. Serum HBV-DNA soon became undetectable in 12 survivors. Of the 12 survivors, after a median treatment period of 101 weeks, a lamivudine-resistant strain with variation in the YMDD motif of the HBV polymerase gene developed in three (25%). None had significant adverse reactions to lamivudine treatment.
Conclusions: These results indicated that lamivudine is effective in the treatment of post-transplant hepatitis B reactivation, including patients with dual chronic hepatitis B and C. Early recognition of HBV reactivation and prompt lamivudine treatment are important to prevent mortality.