Efficacy of Long-Term Treatment with Combination of Lamivudine and Low Dosage Hepatitis B Immuno-Globulin in Preventing Hepatitis B Recurrence After Liver Transplantation

Objective To evaluate the efficacy of long-term treatment with combination of Lamivudine and low dosage hepatitis B immuno-globulin to prevent HB recurrence after liver transplantation,and to investigate long-term prophylaxis protocols.Methods Between October 2003 and August 2005,in the Liver Transplant Center of Third Affiliated Hospital of Sun Yat-sen University,190 cases of orthotopic liver transplantation,which fulfilled the research criteria,were prospectively investigated.All patients received the treatment with the combination of LAM and low dosage intramuscular HBIG.Adefovir was added to this combination when the patient developed lamivudine resistance.HBV re-infection and HB recurrence were monitored based on the HBV maskers,HBV DNA,YMDD mutants,biochemical clinical parameters and histo-pathological manifestation.Result 15 out of 190 cases(7.9%)developed HBV re-infection,in which 7 cases with HB recurrence.ADV was added to the combination of LAM and HBIG for the further treatment of these 7 cases.5 of them achieved significant recovery and 2 of them received a second time of liver transplantation.Another 8 cases of re-infection received further treatment with the supplement of ADV.5 of these cases HBV DNA decreased and 3 cases the HBV DNA test converted to negative,and 1 of these 3 patients was converted to sero-negative for HBsAg.The mean length of follow-up was 12 to 34 months.The median re-injection time was 8.3 months.Conclusion Prophylaxis using lower HBIG doses given intramuscularly in combination with LAM can prevent HBV re-infection and HB recurrence in the hepatitis patients after liver transplantation,and the addition of adefovir may serve as effective supplement therapy for patients with LAM resistance.