Combination Prophylaxis in HBV-positive Liver Transplant Recipients with YMDD Mutants Prevents Hepatitis Recurrence

Recurrence of hepatitis B impairs the outcome of liver transplantation (OLT). In serum hepatitis B virus (HBV)-DNA-positive recipients, prophylaxis using lamivudine (Epivir-HBV) and immunoglobulins (HBIg) reduces the risk of recurrence, but it is undefined whether this regimen also protects candidates with YMDD mutants.

Seventeen OLT viremic candidates received pre-emptive lamivudine followed by post-OLT prophylaxis with lamivudine and HBIg.

Both sera and liver biopsies were prospectively collected and high-sensitive polymerase chain reaction (PCR) assay was applied for HBV-DNA detection. Finally, the presence of YMDD mutants was explored in all PCR-positive samples.

All patients remained hepatitis B recurrence-free after a mean follow up of 32 months.

By PCR, serum HBV-DNA was detectable in 64.3% of cases at OLT-baseline, in 64.7% under combined prophylaxis and in 58.8% in patients (70.5% of the total) with a minimum follow up of 24 months.

At OLT-baseline, YMDD mutants were found in 44.4% of patients. After OLT, mutants were present in 50% of patients but only in 16.6% of cases in the long period.

Although 41% of the native livers and 42.8% of the analysed grafts harboured HBV-DNA, YMDD mutants were detected in 57% of the native positive livers. YMDD mutants were largely detected both at OLT-baseline and post-OLT, but their presence decreased over time. Regardless of the presence of YMDD mutants, no hepatitis B recurrence was observed in our OLT recipients using pre-emptive lamivudine followed by continuous prophylaxis with lamivudine and HBIg.

Dipartimento di Chirurgia Generale e dei Trapianti, U.O. Trapianto Fegato e Polmone, Ospedale Maggiore IRCCS di Milano, Istituto di Chirurgia Sperimentale, Cardiovascolare e dei Trapianti, Universita degli Studi di Milano, Milano, Italy.

02/09/05

Reference
L Caccamo and others. No hepatitis recurrence using combination prophylaxis in HBV-positive liver transplant recipients with YMDD mutants. Transplant International 18(2):186-192. February 2005.

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