To determine the safety and efficacy of ganciclovir usually experience progressive liver disease over an treatment of hepatitis B virus (HBV) infection after liver accelerated time course and pose a difficult managetransplantation, nine patients (seven males, two females; ment challenge. The treatment options for posttransmean age, 38 years) with posttransplant HBV infection plant HBV infection are limited. While interferon is were treated with ganciclovir for 3 to 10 months. Ganeffective therapy for chronic HBV infection, 5 it has not ciclovir was administered intravenously at an initial shown benefit in patients with HBV infection after dose of 5 mg/kg/d and then increased to 10 mg/kg/d. Im- OLT. 6 In a small number of patients with recurrent munosuppressive drug therapy was maintained at low HBV infection after OLT, adenine arabinoside monolevels. There were no major side effects of ganciclovir phosphate treatment decreased serum HBV DNA and therapy. Serum HBV DNA levels decreased by a mean alanine aminotransferase (ALT) levels, which returned of 90% (range, 42% to 100%), and four of nine patients had no measurable HBV DNA at the completion of ther-to baseline when therapy was discontinued. 7 Finally, apy. Mean serum alanine aminotransferase levels deretransplantation for posttransplant HBV infection is creased by 83%. Hepatic expression of HBV antigens and associated with a poor outcome, with recent surveys HBV DNA was assessed before and after therapy in six of transplantation centers from the United States and patients and found to be reduced in three patients. The Europe showing long-term survival rates of only 5% histology activity index was also stabilized or improved and 24%, respectively. in all patients. After discontinuation of therapy, four of Recent preliminary studies showed that a short nine patients underwent retreatment for 4-to 12-fold course of ganciclovir, a nucleoside analogue, decreased elevation of serum HBV DNA and/or biochemical and serum HBV DNA levels in patients with HBV infection clinical relapse, that was severe in one patient. This pilot after organ transplantation. 9 More than 75% reduction study shows the safety and efficacy of ganciclovir therapy for reducing HBV replication in patients with HBV of serum HBV DNA levels was noted in 16 of 17 painfection after liver transplantation. (HEPATOLOGY tients treated with ganciclovir for 2 to 3 weeks after 1996;23:1-7.)
kidney or liver transplantation, but patients relapsed when therapy was discontinued. Maintenance therapy was beneficial in 2 patients treated long-term with ta-Although the long-term administration of hepatitis pering doses. The aim of our study was to determine B immune globulin has been shown to reduce hepatitis whether long-term administration of intravenous gan-B virus (HBV) reinfection and improve survival after ciclovir was safe and effective in patients with recurorthotopic liver transplantation (OLT), 36% of patients rent or de novo HBV infection after OLT. still develop recurrent HBV infection. 1 These patients
PATIENTS AND METHODS
Nine patients (7 male, 2 female) with recurrent (n ร
8) or Abbreviations: HBV, hepatitis B virus; OLT, orthotopic liver transplantade novo (n ร
1) HBV infection after OLT were treated with tion; ALT, alanine aminotransferase; HBsAg, hepatitis B surface antigen; intravenous ganciclovir between September 1992 and April HBeAg, hepatitis B e antigen.