Liver transplantation for patients with lamivudine-resistant HBV: What is the optimal prophylactic strategy?

✍ Scribed by Anna S. F. Lok

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 60 KB
• Volume: 11
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20409

✦ Synopsis

T he use of hepatitis B immune globulins (HBIG) revolutionized liver transplantation for hepatitis B. In the landmark paper by Samuel et al. in 1993, recurrence of hepatitis B virus (HBV) infection 3 years after liver transplantation was reduced from 75% in patients who received no HBIG to 36% in those who received HBIG for at least 6 months. 1 However, the benefit of HBIG was mainly seen in patients with fulminant hepatitis or coexistent hepatitis D virus infection, clinical conditions associated with low HBV replication. Among patients with HBV cirrhosis, the HBV recurrence rate was 83% in those with detectable serum HBV DNA at the time of transplantation and 58% in those with undetectable HBV DNA or hepatitis B e antigen. These results stimulated efforts to reduce HBV replication in patients with HBV cirrhosis while waiting for liver transplantation. Early studies using interferon 2 failed to reduce HBV recurrence because of poor tolerability and low efficacy.

The availability of lamivudine, a nucleoside analog that is safe and effective in suppressing HBV replication, in the 1990s rekindled efforts to treat patients with HBV cirrhosis. Several studies have shown that lamivudine is safe in patients with decompensated cirrhosis and effective not only in suppressing HBV replication, but also in stabilizing or in improving liver disease. 3-7 However, long-term use of lamivudine was limited by the high rate of drug resistance; resistant