Lamivudine treatment for hepatitis B reactivation in HBsAg carriers after organ transplantation: a 4-year experience

J Gastroenterol Hepatol. 2001 Sep;16(9):1001-8. doi: 10.1046/j.1440-1746.2001.02532.x.


Background: Reactivation of hepatitis B after organ transplantation in hepatitis B surface antigen (HBsAg) carriers may be fatal. In this study, we reported our experience of lamivudine treatment in HBsAg carriers who had post-transplant reactivation of hepatitis B.

Methods: The patients were 15 men and one woman. Nine received kidney transplants, six received heart transplants, and one received a lung transplant. They developed a reactivation of hepatitis B 1-101 months (median, 14 months) after transplantation. They received lamivudine 100 mg daily on a compassionate-use basis, and had regular follow ups. The median pretreatment total serum bilirubin level was 3.0 mg/dL, and the alanine aminotransferase level was 357 U/L. Four of the 16 patients were positive for HBeAg. The serum hepatitis B virus (HBV) DNA levels were > 3000 pg/mL in 13 (81%) patients. Three were coinfected with hepatitis C virus.

Results: The overall survival rate was 75%. All four fatal cases had a pretreatment total serum bilirubin level of > or = 3 mg/dL. Serum HBV-DNA soon became undetectable in 12 survivors. Of the 12 survivors, after a median treatment period of 101 weeks, a lamivudine-resistant strain with variation in the YMDD motif of the HBV polymerase gene developed in three (25%). None had significant adverse reactions to lamivudine treatment.

Conclusions: These results indicated that lamivudine is effective in the treatment of post-transplant hepatitis B reactivation, including patients with dual chronic hepatitis B and C. Early recognition of HBV reactivation and prompt lamivudine treatment are important to prevent mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carrier State / drug therapy*
  • Carrier State / immunology
  • DNA, Viral / blood
  • Drug Resistance, Viral / genetics
  • Female
  • Follow-Up Studies
  • Hepatitis B / drug therapy*
  • Hepatitis B / immunology
  • Hepatitis B / mortality
  • Hepatitis B Surface Antigens / blood*
  • Hepatitis B virus / drug effects*
  • Hepatitis B virus / genetics
  • Humans
  • Lamivudine / adverse effects
  • Lamivudine / therapeutic use*
  • Liver Function Tests
  • Male
  • Middle Aged
  • Organ Transplantation*
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / immunology
  • Postoperative Complications / mortality
  • Retrospective Studies
  • Survival Rate
  • Transplantation Immunology
  • Virus Activation / drug effects*


  • DNA, Viral
  • Hepatitis B Surface Antigens
  • Lamivudine