Lamivudine monoprophylaxis for de novo HBV infection in HBsAg-negative recipients with HBcAb-positive liver grafts

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Clin Transplant. 2011 Jan-Feb;25(1):E77-81. doi:

10.1111/j.1399-0012.2010.01329.x. Epub 2010 Oct 11.

Lamivudine monoprophylaxis for de novo HBV infection in HBsAg-negative

recipients with HBcAb-positive liver grafts.

Vizzini G, Gruttadauria S, Volpes R, D'Antoni A, Pietrosi G, Filì D, Petridis I,

Pagano D, Tuzzolino F, Santonocito MM, Gridelli B.

Source

Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo,

Italy. gvizzini@...

Abstract

We followed the efficacy of long-term lamivudine monotherapy in preventing

development of de novo hepatitis B (DNHB) in a large cohort of hepatitis B

surface antigen (HBsAg)-negative recipients with grafts from hepatitis B core

antibody (HBcAb)-positive donors. Recipients were observed over a long

follow-up. Between July 1999 and December 2008, 45 patients (median age 54,

range 19-67) who were HBsAg negative before transplantation were included in the

study of monoprophylaxis with lamivudine starting on post-operative day 1, and

continuing for life. Mean follow-up: 37.9 months; median 32.1 months (range

2.4-117). No suspension of therapy was reported during the study.

Post-transplantation, no DNHB was observed in follow-up: all 45 HBsAg-negative

recipients remained HBsAg and HBV DNA negative. Thirty-four of these

HBsAg-negative recipients were alive at conclusion of the study. A total of 11

patients died, five of HCV recurrence, two of hepatocellular carcinoma (HCC)

recurrence, two of disseminated KSV infection, and two of multiorgan failure

because of early graft dysfunction. Patient and graft survival of HBsAg-negative

recipients with HBcAb-positive donor grafts (45 cases) were not significantly

different from those of the HBsAg-negative recipients with HBcAb-negative donor

grafts (302 cases). In our experience, lamivudine monoprophylaxis provided

complete protection against HBV reactivation and showed long-term efficacy.

© 2010 Wiley & Sons A/S.

PMID: 21039887 [PubMed - indexed for MEDLINE]