Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin

Hepatology. 1998 Aug;28(2):585-9. doi: 10.1002/hep.510280241.


Patients undergoing liver transplantation for hepatitis B-related liver disease are prone to recurrence. The mainstay of prophylaxis has been passive immunotherapy with hepatitis B immune globulin (HBIG). Antiviral therapy with lamivudine has proven effective in lowering hepatitis B virus (HBV) DNA and improving histology in patients with hepatitis B infection; its role in prophylaxis against hepatitis B recurrence following liver transplantation is under investigation. Viral breakthrough and resistance, however, are a significant problem with monotherapy with either HBIG or lamivudine. The efficacy of combination lamivudine/HBIG prophylaxis has not been reported. Fourteen patients underwent transplantation for decompensated liver disease owing to hepatitis B. Lamivudine (150 mg p.o./d) was begun before transplantation in 10 patients, including 4 who were HBV DNA-positive. In addition, 1 patient was HBV DNA-positive when transplanted. HBIG was given perioperatively and continued thereafter; treatment with lamivudine was maintained or initiated at the time of transplantation and continued indefinitely. The median follow-up was 387 days. Actuarial 1-year patient and graft survival was 93% (1 patient died of unrelated causes). At a median interval of 28 days following lamivudine treatment, all 5 HBV DNA-positive patients cleared HBV DNA from the serum; 1 went on to clear hepatitis B surface antigen (HBsAg), before transplantation, at day 148 of lamivudine treatment. By the highly sensitive polymerase chain reaction (PCR), at a median of 346 days (range, 130-525 days) following transplantation, all 13 surviving patients had no detectable serum HBV DNA. Lamivudine suppresses HBV replication in patients awaiting liver transplantation. At a median follow-up of 1.1 years, combination prophylaxis with lamivudine and HBIG prevented hepatitis B recurrence following liver transplantation.

MeSH terms

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Hepatitis B / prevention & control*
  • Hepatitis B / therapy
  • Hepatitis B / virology
  • Hepatitis B virus / physiology
  • Humans
  • Immunization, Passive*
  • Immunoglobulins
  • Lamivudine / therapeutic use*
  • Liver / physiopathology
  • Liver Function Tests
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Postoperative Care
  • Postoperative Complications / prevention & control*
  • Preoperative Care
  • Reverse Transcriptase Inhibitors / therapeutic use*
  • Secondary Prevention
  • Virus Replication / drug effects


  • Immunoglobulins
  • Reverse Transcriptase Inhibitors
  • Lamivudine
  • hepatitis B hyperimmune globulin