Recurrence of hepatitis B virus after a liver transplant is a major risk factor affecting graft and patient survival. Short-term (i.e., 1-2 years) hepatitis B virus reactivation rates was after liver transplant range between 3% and 15%. Using combination prophylaxis, outcomes of liver transplant in patients with liver disease related to hepatitis B virus have been improved to levels comparable to those patients whose disease is not related to hepatitis B virus. Since September 2001, 238 liver transplants have been performed in 234 patients at our center; of these, 65 had liver failure related to hepatitis B virus, and 40 were followed for more than 12 months. Their outcomes were analyzed retrospectively. Our protocol includes lamivudine (100 mg orally per day beginning the day after surgery) and hepatitis B immunoglobulin(10 000 IU IV during the anhepatic phase, 2000 IU/day IV during the first week after surgery, 2000 IU IV/month from the first to the 12th postoperative month). Using our protocol, the anti-HBsAb serum titer was maintained at approximately 100 to 150 IU/mL. The female: male ratio was 9:31. The mean age of patients was 43±13.1 years. Four patients died of causes unrelated to hepatitis B virus 13, 15, 23, and 30 months after liver transplant. At the time of death, their hepatitis B surface antigens (HBsAg) were negative, and serum titers of anti-HBsAb were 35.3, 56.4, 79.6, and 123 IU/mL. Mean 31.5 ± 13.1 months. The HBsAg became positive 15 and 18 months after liver transplants in 2 patients; the remaining 34 patients had negative evidence of HBsAg. In 16 patients, serum titer of anti-HBsAb was 0; in the remaining 18 patients it was 69.2 ± 133 IU/mL. In conclusion; our combination protocol with hepatitis B immunoglobulin and lamivudine is a safe and effective treatment for hepatitis B virus prophylaxis after liver transplant.
Volume : 6
Issue : 4
Pages : 73
Department of General Surgery and Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey