Prophylaxis Against Hepatitis B Recurrence Posttransplantation Using Lamivudine and Individualized Low-Dose Hepatitis B Immunoglobulin

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http://www3.interscience.wiley.com/journal/123591694/abstract

American Journal of Transplantation

Volume 10 Issue 8, Pages 1861 - 1869

Published Online: 23 Jul 2010

© 2010 American Society of Transplantation and the American Society of

Transplant Surgeons

Prophylaxis Against Hepatitis B Recurrence Posttransplantation Using Lamivudine

and Individualized Low-Dose Hepatitis B Immunoglobulin

L. Jiang a , L. Yan a,*, B. Li a , T. Wen a , J. Zhao a , L. Jiang b , N. Cheng

b , Y. Wei

a , J. Yang a , M. Xu a and W. Wang a

a Liver Transplantation Center, Department of Liver Surgery , b Department

of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan

Province, China

* Corresponding author: Lunan Yan, yanlunanhx@...

American Society of Transplantation and the American Society of

Transplant Surgeons

ABSTRACT

Although the combination of lamivudine (LAM) and high-dose intravenous (IV)

hepatitis B immunoglobulin (HBIG) is very effective in preventing hepatitis B

virus (HBV) recurrence after liver transplantation (LT), the major limitation of

this regimen is its high cost. A more cost-effective, convenient and widely

accepted regimen is urgently needed. We evaluated the safety and efficacy of

another strategy using LAM and individualized low-dose intramuscular (IM) HBIG.

Between May 2002 and December 2009, a total of 254 adult patients undergoing LT

for HBV-related benign end-stage liver diseases received this regimen in our

center. The mean follow-up of these patients was 41.2 ± 22.7 months. Their 1-,

3- and 5-year survival rates were 85.3%, 77.4% and 76.4%, respectively, and 1-,

3- and 5-year HBV recurrence rates were 2.3%, 6.2% and 8.2%. Fourteen patients

experienced posttransplant HBV recurrence. Pretransplant high viral load and

posttransplant prednisone withdrawal time were observed to be associated with

recurrence. In conclusion, combination therapy with LAM and individualized

low-dose IM HBIG provides a safe and effective prophylaxis against HBV

recurrence after LT at about 5% of the cost of conventional high-dose IV HBIG

regimens.

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Received 02 March 2010, revised 02 Jun 2010 and accepted for publication 07 Jun

2010

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1600-6143.2010.03208

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