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Low-dose Hepatitis B Immune Globulin (HBIG) and Higher-dose Lamivudine
Combination Prevents HBV Recurrence After Liver Transplantation
Post-transplant
prevention of hepatitis B virus (HBV) infection is based
on treatment with lamivudine
(Epivir-HBV) and/or hepatitis
B immune globulin (HBIG). However, optimum doses and
duration for these drugs are not yet clear.
Turkish
researchers tested high doses of lamivudine (300 mg/day) in combination
with low doses of HBIG (200-400 IU/2-4 weeks).
Eighty
patients who had post-transplant prophylaxis of lamivudine and HBIG
were included in the study. Of those, 20 had hepatitis D virus co-infection
and eight were HBV DNA-positive at the time of transplantation.
Ten
HBV DNA-positive patients were treated with lamivudine (150 mg/day)
before transplantation; all were HBV DNA-negative after lamivudine
treatment.
All
patients in the anhepatic phase were given 4000 IU of HBIG. Following
this, 400 or 800 IU HBIG was administered intramuscularly daily
for 5-10 days post-transplantation and 2-4 times weekly thereafter,
according to serum titre of antibodies to hepatitis B surface antigen
(anti-HBs).
Lamivudine
was maintained or initiated at the time of transplantation and was
continued indefinitely. Median follow-up was 21 months (range 3-73
months).
Results
Recurrence
of hepatitis B surface antigen (HBsAg)-positivity
occurred in only three out of 78 (4%) patients; two of these three
were HBV DNA-positive.
Median
anti-HBs titre at the final follow-up was 68 IU. Patient and graft
survival was 85% at 1 year.
The
authors conclude, “In conclusion, a combination of lamivudine 300
mg/day and low-dose HBIG prevents post-transplantation recurrence
of hepatitis B, even in the presence of viral replication in the
pre-transplant period.”
Department
of Gastroenterology, Ege University Medical School, Bornova, Izmir,
Turkey.
01/21/05
Reference
Z
Karasu and others. Low-dose hepatitis B immune globulin and higher-dose lamivudine
combination to prevent hepatitis B virus recurrence after liver
transplantation. Antiviral Therapy 9(6): 921-927. December 2004.
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