A research team from Canada and the USA assessed the effectiveness of lamivudine monotherapy before and after liver transplantation for chronic hepatitis B.
77 liver transplant candidates were enrolled in the multi-center study in which patients were treated with lamivudine (100 mg daily), without the adjunctive use of hepatitis B immune globulin.
Treatment was begun while patients awaited liver transplantation and continued after transplantation.
All patients were hepatitis B surface antigen (HBsAg) positive, and 61% had detectable hepatitis B e antigen (HBeAg) and HBV DNA when treatment was begun.
47 underwent liver transplantation and 30 did not.
60% of transplanted patients, with 12 or more weeks of post-transplantation follow-up, were HBsAg negative at the last study visit. At Treatment Week 156, 59% remained HBsAg negative, and all reinfected patients were HBV-DNA positive before treatment.
|At Treatment Week 156, 59% of transplanted patients remained HbsAg negative.
In the non-transplanted patients, HBeAg was initially detectable in 74%, but this decreased to 18% after 104 weeks of treatment. Significant improvement in biochemical parameters was observed.
HBV-DNA polymerase mutants were detected in 21% and 20% of the transplanted and non-transplanted patients, respectively.
When compared with historical cohorts, lamivudine-treated patients appeared to have improved survival, and transplanted patients had a decrease in the rate of recurrent HBV infection, the authors observed.
Robert P. Perrillo, of the Ochsner Clinic, New Orleans, Los Angeles, concluded on behalf of the group, "Lamivudine therapy was partially effective in preventing recurrent HBV infection when given before and after transplantation. Thus, future trials using a combination of HBIg and lamivudine are needed to assess the optimal prophylactic therapy."