Abstract
In this study, the longโterm (>3 years) efficacy of combination therapy for hepatitis B virus (HBV) recurrence and the associated factors were investigated. One hundred and sixtyโfive consecutive HBsAgโpositive patients (92 with liver cirrhosis, 73 with hepatocellular carcinoma; HCC) who underwent liver transplantation were assessed with a median followโup time of 40 months. One hundred and twentyโone patients (121/165, 73.3%) were treated with lamivudine before transplantation for a mean of 8.4 months (range 0.1โ72 months). The postโtransplantation treatment protocol consisted of a high dose intravenous hepatitis B immunoglobulin (HBIg) followed by a low dose intramuscular HBIg and lamivudine combination therapy. Seven (4.2%, 7/165) recipients experienced HBV recurrence at a median time of 19 months (range 5โ36 months) following transplantation. Six of seven cases of HBV recurrence were treated with lamivudine before transplantation for a median period of 15 months (range 0.6โ30 months). Eighteen (24.6%, 18/73) patients had HCC recurrences after transplantation. Of the four patients with both HCC and HBV recurrence, three experienced HBV recurrence after recurrence of HCC. The clinical factor associated with HBV recurrence in the total cohort (nโ=โ165) was the duration of antiviral treatment (over 6 months) before transplantation (Pโ=โ0.004). In the HCC group, HCC recurrence after transplantation (Pโ=โ0.002), tumor burden before transplantation (Pโ=โ0.005), and postoperative adjuvant chemotherapy (Pโ=โ0.002), were additional factors for HBV recurrence. Combination therapy of HBIg and antiviral drugs was effective over 3 years regardless of the pretransplantation viral load. However, the possible recurrence of HBV needs to be monitored cautiously in patients treated with longโterm (over 6 months) lamivudine. J. Med. Virol. 80:1891โ1899, 2008. ยฉ 2008 WileyโLiss, Inc.