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Randomized trial of lamivudine versus hepatitis B immunoglobulin for long-term prophylaxis of hepatitis B recurrence after liver transplantation

Lookup NU author(s): Dr Alberto Lopes, Professor Margaret Bassendine

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Abstract

Background/Aims: The long-term prophylaxis of hepatitis B after liver transplantation requires further optimization. In a randomized trial we investigated a regimen where the initially given hepatitis B immunoglobulin (HBIg) is replaced by long-term lamivudine treatment. Methods: Twenty-four liver transplant recipients (all HBsAg-positive/HBV DNA-negative before transplantation), who had received HBIg for at least 6 months without HBV recurrence, were randomized to receive lamivudine (n = 12) or HBIg (n = 12) for 52 weeks. The efficacy criteria involved seronegativity for HBsAg and undetectable HBsAg/ HBcAg in the liver. Results: Twenty-one of 24 patients completed the study without hepatitis B virus (HBV) recurrence (11 on HBIg, ten on lamivudine), while three patients became HBsAg-positive. Amongst those without HBV recurrence HBV DNA was detectable only by polymerase chain reaction, intermittently in serum and lymphocytes, and in liver specimens from six of eight patients receiving HBIg and five of seven receiving lamivudine. YMDD variant was found in four cases with no viral antigen expression. Eight patients continued lamivudine after the study and during an additional 6-22 months remained HBsAg-negative with normal graft function. Conclusions: Substitution of HBIg with lamivudine is effective for prevention of HBV recurrence in low-risk liver transplant recipients and offers a convenient and cost-effective alternative for long-term HBV prophylaxis. (C) 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.

Publication metadata

Author(s): Bassendine M; Lopes AR; Naoumov NV; Burra P; Caccamo L; Iemmolo RM; de Man RA; O'Grady JG; Portmann BC; Anschuetz G; Barrett CA; Williams R; Atkins M

Publication type: Article

Publication status: Published

Journal: Journal of Hepatology

Year: 2001

Volume: 34

Issue: 6

Pages: 888-894

ISSN (print): 0168-8278

ISSN (electronic): 1600-0641

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/S0168-8278(01)00039-3

DOI: 10.1016/S0168-8278(01)00039-3

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