Lamivudine after hepatitis B immune globulin is effective in preventing hepatitis B recurrence after liver transplantation

Liver Transpl. 2000 Jul;6(4):434-9. doi: 10.1053/jlts.2000.6446.


The prevention of recurrent hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT) with hepatitis B immunoglobulin (HBIG) is expensive and requires indefinite parenteral administration. Lamivudine is a nucleoside analogue capable of inhibiting HBV replication. The aim of this study is to determine the efficacy of lamivudine in the prevention of recurrent HBV infection after a course of HBIG in patients who were hepatitis B surface antigen (HBsAg) positive and hepatitis Be antigen (HBeAg) negative before OLT. Patients at high risk for recurrent HBV infection (HBeAg positive and HBV DNA positive) were excluded. Thirty HBsAg-positive, HBeAg-negative patients underwent OLT from January 1993 to June 1997. All 30 patients were administered HBIG after OLT and, after 2 years, were given the option of continuing with HBIG or switching to lamivudine. Five patients were excluded: 3 patients were lost to follow-up and 2 patients died of technical complications. Three patients terminated HBIG therapy at 8, 24, and 29 months after OLT, and reinfection with HBV occurred in 1 patient. Six patients elected to continue HBIG therapy for life; 1 patient died of melanoma and the remaining 5 patients are HBsAg negative, with an average follow-up of 73 months. Sixteen patients were converted to lamivudine after a course of HBIG, and all 16 patients are HBsAg negative, with an average follow-up of 51 months after OLT. Five patients have been on lamivudine monotherapy for more than 24 months. These results suggest that lamivudine administered after a posttransplantation course of HBIG can effectively prevent the recurrence of HBV infection in patients who are HBsAg positive and HBeAg negative before OLT.

MeSH terms

  • Adult
  • Aged
  • Drug Therapy, Combination
  • Female
  • Hepatitis B / etiology
  • Hepatitis B / prevention & control*
  • Hepatitis B Surface Antigens / blood
  • Humans
  • Immunization, Passive*
  • Immunoglobulins / therapeutic use*
  • Immunoglobulins, Intravenous
  • Lamivudine / therapeutic use*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications / prevention & control*
  • Secondary Prevention


  • Hepatitis B Surface Antigens
  • Immunoglobulins
  • Immunoglobulins, Intravenous
  • Lamivudine
  • hepatitis B hyperimmune globulin