High pre-treatment serum hepatitis B virus titre predicts failure of lamivudine prophylaxis and graft re-infection after liver transplantation
Section snippets
Patients and Methods
Ten consecutively treated patients who survived at least 3 months after liver transplantation were studied. Eight of these patients participated in the aforementioned study which evaluated the use of lamivudine as prophylaxis against graft re-infection following transplantation for HBV-associated end-stage chronic liver disease (10). That study was approved by the research ethics committee, and patient consent was obtained. Another two patients were transplanted subsequent to closure of trial
Results
Ten HBsAg-positive patients were studied (see Table 1). Patients were studied from the time of commencement of lamivudine until 1/9/98. The median duration of lamivudine treatment prior to transplantation was 60 days (range 36–170). Two patients died of recurrent HBV infection, (both due to emergence of lamivudineresistant species) 505 and 704 days post-transplant respectively. For eight survivors, the median duration of follow-up post-transplant was 966 days (range 480–1557).
Discussion
Following liver transplantation, recurrent HBV infection is associated with significant morbidity, and with diminished graft and patient survival. To date, strategies to prevent graft re-infection have required the administration of HBV hyperimmune immunoglobulin (HBIg). HBIg prophylaxis has proven quite successful for prevention of recurrent infection in those patients with low levels of viral replication prior to transplantation. For patients with higher levels of replication (defined as
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