No hepatitis recurrence using combination prophylaxis in HBV-positive liver transplant recipients with YMDD mutants

Authors

  • Lucio Caccamo,

    1. Dipartimento di Chirurgia Generale e dei Trapianti, U.O. Trapianto Fegato e Polmone, Ospedale Maggiore IRCCS di Milano, Istituto di Chirurgia Sperimentale, Cardiovascolare e dei Trapianti, Università degli Studi di Milano, Milano, Italy
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  • Raffaella Romeo,

    1. Dipartimento di Gastroenterologia ed Endocrinologia, U.O. Epatologia Medica, Ospedale Maggiore IRCCS, Università degli Studi di Milano, Milano, Italy
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  • Giorgio Rossi,

    1. Dipartimento di Chirurgia Generale e dei Trapianti, U.O. Trapianto Fegato e Polmone, Ospedale Maggiore IRCCS di Milano, Istituto di Chirurgia Sperimentale, Cardiovascolare e dei Trapianti, Università degli Studi di Milano, Milano, Italy
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  • Mauro Maggioni,

    1. Dipartimento di Medicina Chirurgia ed Odontoiatria, II Cattedra di Anatomia Patologica, Ospedale S. Paolo, Università degli Studi di Milano, Milano, Italy
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  • Ferdinando Radice,

    1. Anatomia e Istologia Patologica, Ospedale Maggiore IRCCS, Università degli Studi di Milano, Milano, Italy
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  • Giovanna Lunghi,

    1. Laboratorio di Virologia, Ospedale Maggiore IRCCS di Milano, Milano, Italy
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  • Massimo Colombo,

    1. Dipartimento di Gastroenterologia ed Endocrinologia, U.O. Epatologia Medica, Ospedale Maggiore IRCCS, Università degli Studi di Milano, Milano, Italy
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  • Luigi R. Fassati

    1. Dipartimento di Chirurgia Generale e dei Trapianti, U.O. Trapianto Fegato e Polmone, Ospedale Maggiore IRCCS di Milano, Istituto di Chirurgia Sperimentale, Cardiovascolare e dei Trapianti, Università degli Studi di Milano, Milano, Italy
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Lucio Caccamo MD, PhD, Centro Trapianto Fegato, Ospedale Maggiore IRCCS, Via F. Sforza 35, I-20122 Milano, Italy. Tel.: +39-0255-035140; fax: +39-0255-035800; e-mail: lucio.caccamo@libero.it

Summary

Recurrence of hepatitis B impairs the outcome of liver transplantation (OLT). In serum hepatitis B virus (HBV)-DNA-positive recipients, prophylaxis using lamivudine and immunoglobulins (HBIg) reduces the risk of recurrence, but it is undefined whether this regimen also protects candidates with YMDD mutants. Seventeen OLT viraemic candidates received pre-emptive lamivudine followed by post-OLT prophylaxis with lamivudine and HBIg. Both sera and liver biopsies were prospectively collected and high-sensitive polymerase chain reaction (PCR) assay was applied for HBV-DNA detection. Finally, the presence of YMDD mutants was explored in all PCR-positive samples. All patients remained hepatitis B recurrence-free after a mean follow up of 32 months. By PCR, serum HBV-DNA was detectable in 64.3% of cases at OLT-baseline, in 64.7% under combined prophylaxis and in 58.8% in patients (70.5% of the total) with a minimum follow up of 24 months. At OLT-baseline, YMDD mutants were found in 44.4% of patients. After OLT, mutants were present in 50% of patients but only in 16.6% of cases in the long period. Although 41% of the native livers and 42.8% of the analysed grafts harboured HBV-DNA, YMDD mutants were detected in 57% of the native positive livers. YMDD mutants were largely detected both at OLT-baseline and post-OLT, but their presence decreased over time. Regardless of the presence of YMDD mutants, no hepatitis B recurrence was observed in our OLT recipients using pre-emptive lamivudine followed by continuous prophylaxis with lamivudine and HBIg.

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