Living donor liver transplantation for hepatitis B cirrhosis

Abstract

The living donor liver transplantation (LDLT) experience for patients with hepatitis B virus (HBV) infection is still limited. Because LDLT can be performed electively, it can provide an appropriate length of time to reduce HBV DNA levels before the operation. This study aims to examine the feasibility of our protocol for preventing HBV reinfection after LDLT. Of 20 patients analyzed, 15 patients had detectable serum HBV DNA when referred to our hospital. Thirteen patients had hepatocellular carcinoma. All patients were treated with lamivudine (100 mg/d) before LDLT. After LDLT, hepatitis B immunoglobulin (HBIG) was administered to maintain serum antibody to hepatitis B surface antigen titers at greater than 1,000 IU/mL for 1 year and 200 IU/mL thereafter. Lamivudine was not administered postoperatively, except for three patients with detectable serum HBV DNA just before LDLT. All patients survived the operation. One patient died 229 days after LDLT of carcinoma recurrence. In the other 19 patients, liver function has remained normal and no viral relapse occurred postoperatively during a median follow-up of 19 months. Perioperative use of lamivudine and indefinite HBIG administration in the postoperative period might be a rational strategy for preventing HBV reinfection after LDLT.

Advances in adult living donor liver transplantation: A review based on reports from the 10th anniversary of the adult-to-adult living donor liver transplantation meeting in Tokyo

“…The 5‐year cumulative mutant‐free survival was 86%. In contrast, the Tokyo University group43 presented satisfactory results of LDLT for HBV (n = 20) using hepatitis B immunoglobulin monotherapy. The use of lamivudine was limited to the perioperative period to avoid generating mutants.…”

One‐year extended, monthly vaccination prophylaxis combined with hepatitis B immune globulin for hepatitis B after liver transplantation

“…Prophylactic post‐transplant treatment was based on HBIG monotherapy during this study period . HBIG (Mitsubishi Tanabe Pharma; Hebsbulin‐IH, Osaka, Japan) was administrated during the anhepatic phase (10 000 units) and just after the end of the operation (10 000 units).…”

Double‐dose double‐phase use of second generation hepatitis B virus vaccine in patients after living donor liver transplantation: Not an effective measure in transplant recipients

“…Postoperatively, HBIG (Mitsubishi Tanabe Pharma, Hebsbulin‐IH, Tokyo, Japan) was administered to HBV‐infected patients and those who received HBcAb‐positive donor organs. Details of the HBIG administration protocol and doses are described elsewhere 16 . In brief, HBIG was administered to maintain the anti‐HB surface antibody (HbsAb) levels at greater than 1000 IU/L for patients with HBV and greater than 500 IU/L for patients that received HBcAb‐positive donor organs.…”

“…At the University of Tokyo, we use HBIG mono‐prophylaxis 16 . The ultimate goal of vaccination is to achieve sufficient production of anti‐hepatitis B immunoglobulin and to discontinue further prophylaxis against recurrent hepatitis B.…”