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Editor,—We read with interest the article by Mutimer and colleagues (Gut2000;46:107–113). The Birmingham group described the clinical course of four liver transplant patients who developed graft infection with lamivudine resistant virus. Lamivudine resistant hepatitis B developed after a mean duration of nine months (range 8–11) after the transplant. Liver function abnormalities occurred at a mean duration of six months (range 3–12) after the emergence of lamivudine resistant virus and three of the four patients died 5–20 months later. The authors concluded that the lamivudine resistant phenotype can cause severe graft damage.
In our liver transplant centre, 12 patients with chronic hepatitis B (four with hepatocellular carcinoma) underwent liver transplantation over a five year period. All were given lamivudine before and after transplant. Lamivudine resistant hepatitis B developed in six of the nine survivors at a mean duration of 60 weeks (range 1–127) after liver transplant. Apart from weaning off immunosuppression aggressively, no further antiviral treatment was added. All six had normal liver function at their last follow up (mean 28, range 0–123 weeks after emergence of lamivudine resistant virus).
Contrary to what the Birmingham group experienced, all of our patients with lamivudine resistant virus were well, with no evidence of graft dysfunction. Long term outcome of such patients remains unknown and it may be premature to conclude that the lamivudine resistant phenotype causes severe graft damage.
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