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HBV
Viral Load at the Time of Liver Transplantation Determines the Risk
of HBV Recurrence and Indicates the Best Prophylaxis Strategy
Hepatitis
B virus (HBV) recurrence after liver
transplantation is significantly reduced by prophylaxis
with hepatitis B immune globulins
(HBIG) or antiviral drugs
in non-replicating patients and by the combination of both drugs
in replicating patients. However, the load of HBV DNA, which defines
replicating status in patients undergoing liver transplantation,
remains unclear.
This study analyzes the correlation between the viral load,
tested with a single amplified assay, at the time of liver transplantation,
and the risk of hepatitis B recurrence in 177 HBV carriers who underwent
transplantation in a single center from 1990 to 2002.
Overall, HBV relapsed after surgery in 15 patients (8.5%) with
a 5- and 8-year actuarial rate of recurrence of 8% and 21%, respectively.
After liver transplantation hepatitis B recurred in 9% of 98
selected subjects treated only with immune globulins and in 8% of
79 viremic patients who received immune
globulins and lamivudine (P = NS).
A linear correlation was observed between recurrence and viral
load at the time of surgery.
In transplant patients with HBV DNA higher than 100,000 copies/mL,
200-99,999 copies/mL, and DNA undetectable by amplified assay, hepatitis
B recurred in 50%, 7.5%, and 0% of patients, respectively.
Overall, a viral load higher than 100,000 copies/mL at the
time of liver transplantation was significantly associated with
hepatitis B recurrence (P = .0003).
The authors conclude, “In conclusion, spontaneous or antiviral-induced
HBV DNA viral load at the time of surgery classifies the risk of
HBV recurrence after liver transplantation and indicates the best
prophylaxis strategy.”
Department
of Gastroenterology, San Giovanni Battista Hospital, Turin, Italy.
03/23/05
Reference
A Marzano and others. Viral load at the time of liver transplantation
and risk of hepatitis B virus recurrence. Liver Transplantation
11(4): 402-409. March 2005 [Epub ahead of print]
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