The outcome of patients with Hepatitis B virus and human immunodeficiency virus (HIV) referred for liver transplantation is unknown.
A high frequency of lamivudine-resistant Hepatitis B may increase the risk of liver-related death pre-transplantation and prophylaxis failure post-transplantation.
Dr Norah Terrault and colleagues evaluated the association of lamivudine-resistant Hepatitis B virus on pre-transplant survival.
The investigative team also assessed the association of lamivudine-resistant Hepatitis B and post-transplant outcomes.
The team included 35 consecutive HIV/Hepatitis B coinfected patients referred for liver transplantation between 2000 and 2002.
At the time of referral, the median CD4 count was 273/mm, MELD was 14, and lamivudine-resistant Hepatitis B virus infection was present in 67%.
|Hep B virus DNA was not detected after Hep B immune globulin plus lamivudine|
The investigators listed 26% of the referred patients, and 29% were not listed due to relative or absolute contraindications.
Those not listed were too sick for liver transplantation, or it was too early for liver transplantation, and some patients died during transplant evaluation.
Of the 9 listed patients, 4 remained listed, 1 died 18 months post-referral, and 4 were transplanted 3 to 40 months after listing.
Of 17 evaluated but not listed patients, the team reported that 5 died.
The investigators observed that all deaths were liver-related.
All the HIV/Hepatitis B coinfected patients who were transplanted, were Hepatitis B antigen negative.
The team found that the patients had undetectable Hepatitis B virus DNA levels on prophylactic therapy using Hepatitis B immune globulin plus lamivudine.
The investigators did not detect the virus DNA in patients on prophylactic therapy, with and without tenofovir or adefovir, after about 33 months follow-up.
Dr Terrault's team commented, “Late referral and the presence of lamivudine-resistant Hepatitis B virus pre-transplantation are common in referred HIV/Hepatitis B coinfected patients.”
“In these patients undergoing liver transplantation, Hepatitis B virus recurrence is successfully prevented with combination prophylaxis using Hepatitis B immune globulin and antivirals.”