New Era of Liver Transplantation for Hepatitis B

Anselmo, Dean M.; Ghobrial, Rafik M.; Jung, Lee Chan; Weaver, Michael; Cao, Carlos; Saab, Sammy; Kunder, Greg; Chen, Pauline W.; Farmer, Douglas G.; Yersiz, Hasan; Baquerizo, Angeles; Geevarghese, Sunil K.; Han, Steven; Goldstein, Leonard I.; Holt, Curtis; Gornbein, Jeffrey; Busuttil, Ronald W.

doi:10.1097/00000658-200205000-00002

Cited by 101 publications

(94 citation statements)

References 25 publications

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“…A number of reports [18][19][20] have been published in this field. However, all studies were performed after DLT.…”

Section: Discussionmentioning

confidence: 99%

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Living donor liver transplantation for hepatitis B cirrhosis

Sugawara¹,

Makuuchi²,

Kaneko³

et al. 2003

Liver Transplantation

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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.

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“…A number of reports [18][19][20] have been published in this field. However, all studies were performed after DLT.…”

Section: Discussionmentioning

confidence: 99%

“…The detailed preoperative protocol remains unclear. The UCLA series 18 included 166 patients who underwent DLT for chronic HBV infection during a 17-year period. However, the preoperative strategy changed over time.…”

Section: Discussionmentioning

confidence: 99%

Living donor liver transplantation for hepatitis B cirrhosis

Sugawara¹,

Makuuchi²,

Kaneko³

et al. 2003

Liver Transplantation

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“…The initial results were very encouraging demonstrating disappearance of HBV DNA prior to OLT and absence of HBV recurrence [45]. In these studies, the HBV recurrence rate at 1-2 years were less than 10% [45,57,[64][65][66][67][68][69][70][71][72] (table 4). In addition HBV DNA was found to be negative by PCR in most cases at one-year post-OLT.…”

Section: Combination Of Lamivudine and Hbigmentioning

confidence: 97%

Liver transplantation for hepatitis B virus-related liver disease: Indications, prevention of recurrence and results

Roche

Samuel

2003

Journal of Hepatology

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“…11,13 Because of the problem of viral mutation leading to viral escape with the use of both lamivudine and HBIg, many programs have combined the use of lamivudine with HBIg. 7,15,16 Neither the optimal dosage and treatment interval nor the utility of measuring antibody to HBsAg titers to monitor therapy in this setting have been established. However, it appears that much lower doses of HBIg are required when combined with lamivudine, and the rate of acquired viral resistance is much lower.…”

mentioning

confidence: 99%

“…2,[5][6][7][8] Using HBIg alone to prevent recurrent HBV infection was most effective in those at lower risk for recurrent infection, i.e., patients with hepatitis D virus coinfection or acute hepatitis B or those who were HBV DNA negative in serum. 2,5 However, intravenous administration of HBIg is costly, i.e., currently $74,320 for eight daily doses of HBIg during the first week post-OLT and monthly thereafter and approximately $45,000 per annum after year 1 (local data).…”

mentioning

confidence: 99%

Hepatitis B immune globulin for life versus limited use: I favor limited duration of therapy

Lake

2002

Liver Transplantation

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T he initial enthusiasm for performing orthotopic liver transplantation (OLT) on patients with chronic hepatitis B virus (HBV) infection was tempered in the early 1990s by a high rate of recurrent infection, with the subsequent development of severe recurrent hepatitis frequently leading to loss of the allograft. 1 In the absence of effective therapy, recurrent infection, defined as the appearance after OLT of detectable hepatitis B surface antigen (HBsAg) in serum, occurred in 70% to 90% 2 of patients who were HBsAg positive preoperatively. Subsequent histological findings of hepatitis were seen in most patients, including the lesion termed fibrosing cholestatic hepatitis. 3 This lesion is marked by overexpression of HBV proteins in hepatocytes, with cellular swelling and cholestasis, but only minimal inflammation. These observations suggested that HBV may be directly cytopathic in the post-OLT setting. Fortunately, most patients who clear HBsAg after OLT have a normal liver on histological studies and a benign clinical course. 2 Patients at greatest risk for developing recurrent HBV infection are those with chronic HBV infection and, in particular, detectable HBV DNA or hepatitis B e antigen in serum before OLT. 2,4 Patients at lower risk for reinfection include patients with acute HBV infection and those coinfected with hepatitis D virus, which appears to suppress HBV replication.A major breakthrough came when several studies showed that hepatitis B immune globulin (HGIg) administered intravenously in high doses during and after OLT could substantially reduce the risk for reinfection, leading to improved survival rates. 2,[5][6][7][8] Using HBIg alone to prevent recurrent HBV infection was most effective in those at lower risk for recurrent infection, i.e., patients with hepatitis D virus coinfection or acute hepatitis B or those who were HBV DNA negative in serum. 2,5 However, intravenous administration of HBIg is costly, i.e., currently $74,320 for eight daily doses of HBIg during the first week post-OLT and monthly thereafter and approximately $45,000 per annum after year 1 (local data). When used alone, it may be required for life. Late breakthroughs also have occurred in patients who develop a variety of mutations in the HBV S gene. 9 For these reasons, there is an extreme need for true antiviral agents that might inhibit viral replication and prevent HBV reinfection when used pre-OLT. Several nucleoside analogues have been shown to meet such criteria. 8,10,11 The first such agent, lamivudine, has been shown to markedly decrease the rate of HBV reinfection after OLT, even when administered alone. 10,12 Lamivudine is very well tolerated and much less expensive than HBIg. The major limitation to its use is the development of resistance through viral mutation at the YMDD locus of the polymerase molecule. 10,13,14 Resistance develops in up to 30% of transplant recipients by 1 year. Moreover, severe recurrent disease has occurred in patients after the development of viral breakthrough. 11,13 Because of the pr...

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New Era of Liver Transplantation for Hepatitis B

Cited by 101 publications

References 25 publications

Living donor liver transplantation for hepatitis B cirrhosis

Living donor liver transplantation for hepatitis B cirrhosis

Liver transplantation for hepatitis B virus-related liver disease: Indications, prevention of recurrence and results

Hepatitis B immune globulin for life versus limited use: I favor limited duration of therapy

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