[Lamivudine as prophylaxis against hepatitis B virus reinfection following orthotopic liver transplantation].

OBJECTIVE

To discuss the effect of lamivudine as prophylaxis against hepatitis B virus (HBV) reinfection following orthotopic liver transplantation (OLT).

METHODS

40 patients with HBV-related diseases received lamivudine, 100 mg/day, as prophylaxis against HBV reinfection after OLT. Hepatitis B serum markers, HBsAg, HBeAg, HBcAb-IgM, and HBcAg were detected every 2 weeks by immunohistochemistry. Serum HBV-DNA was examined by PCR every 2 weeks. Liver biopsy was conducted to the donor livers during operation and to the transplanted livers postoperatively in regular interval. HBsAg and HBcAg in the liver specimens were examined by immunohistochemistry. YMDD mutation sequencing was done to those patients with conversion of positive HBV DNA postoperatively.

RESULTS

The positive rates were 100%, 25%, and 30% for the serum HBsAg, HBeAg, and HBV DNA of the patients respectively before OLT. All 40 donor liver specimens showed negative HBsAg and HBcAg. HBV reinfection rates were 12.2% and 23.5% 6 months and 12 months after OLT respectively. HBeAg had been positive in 4 out of the 6 cases with postoperative reinfection and had been positive in 8 out of the 34 cases without reinfection (P = 0.4505). HBV DNA had been positive in 5 out of the 6 cases with postoperative reinfection, and had been positive in 7 out of the 34 cases without reinfection (P = 0.0461). After OLT HBV DNA converted to positive in 4 cases, mutation of YMDD locus (YMDD-YIDD) had been found in 3 of which.

CONCLUSION

Lamivudine monotherapy is effective against HBV reinfection after OLT. Given the lamivudine monotherapy, HBV reinfection causes mutation in YMDD locus on the HBV DNA polymerase gene. OLT does not apply in patients with positive HBV DNA. For those patients to be operated upon, lamivudine should be used to convert HBV DNA to negative beforehand.