Long-term outcome of patients with lamivudine after early cessation of hepatitis B immunoglobulin for prevention of recurrent hepatitis B following liver transplantation

Background: The aim of this study is to examine the efficacy of long-term prophylaxis with lamivudine (LAM) after a course of post-operative hepatitis B immunoglobulin (HBIG) in patients who underwent liver transplantation (LT) for hepatitis B virus (HBV)-related disease.
Result: The medical records of HBV-infected patients who underwent a LT in our institution between July 2001 and May 2005 were reviewed. There were 15 liver transplant recipients who were administered HBIG for <18 months and used LAM as a maintenance prophylaxis regime enrolled in this study. At enrollment, all patients were hepatitis B surface antigen (HBsAg) positive and three patients were HBeAg positive. There were 13 patients who were HBV DNA positive with a mean viral load of 5.4 log copies/mL, and among them, 12 recipients were on antiviral therapy with LAM (100 mg/d orally) for 12-168 d, resulting in HBV DNA negative levels in nine patients prior to their transplant. HBV recurrence post-LT was noted in two patients who had very high-HBV DNA levels pre-LT. Both of these patients showed LAM-resistant mutation at the time of recurrence. The 11 patients who were HBV DNA negative before LT (low-risk patients) had no HBV recurrence during a follow-up at a median of 58 months post-LT. This included five patients who had intermittent low-level HBV DNA post-LT (HBsAg negative), of whom two had YMDD mutation and these two were given adefovir in addition to LAM.
Conclusion: Our retrospective study demonstrated excellent long-term outcomes in the low-risk patients treated with LAM after a short course of HBIG.