Exclusion of liver grafts from hepatitis B core antibody (anti-HBc) positive donors to prevent de novo hepatitis B virus (HBV) infection after liver transplantation is not feasible in some areas.
In countries like Taiwan, approximately 80% of adults are anti-HBc positive.
|No patients given lamivudine developed de novo HBV infection during follow up.|
The efficacy of lamivudine monotherapy to prevent de novo HBV infection after living donor liver transplantation, using grafts from anti-HBc positive donors, remains to be clarified.
In this study, researchers from Kaohsiung, Taiwan, assessed 42 patients who received living donor liver transplantation, between 1994 and 2000; 57% of the donors were anti-HBc positive.
The research team administered pre-transplant HBV vaccination to all recipients irrespective of anti-HBc status at monthly intervals for 3 months.
Prior to December 1997, recipients received liver grafts from anti-HBc positive donors without prophylaxis (n = 8).
However, since January 1998, prophylaxis with lamivudine monotherapy was given to recipients of liver grafts from anti-HBc positive donors (n = 16).
The research team found that de novo HBV infection occurred in 38% of recipients who did not receive prophylaxis.
However, none of the 16 patients given lamivudine developed de novo HBV infection after a mean follow-up of 25 months.
Furthermore, the team found that lamivudine was well tolerated, and no side effects were noted.
Dr Yaw-Sen Chen's team concluded, "These results suggest that lamivudine monotherapy for recipients receiving anti-HBc positive liver grafts is a simple, relatively inexpensive and effective prophylactic regimen for prevention of de novo HBV infection".
"The additive protection provided by vaccine-induced or natural immunity is uncertain".