Orthotopic liver transplantation for patients with hepatitis B virus–related liver disease

Abstract

Fifty‐nine patients with prior hepatitis B virus infection underwent orthotopic liver transplantation. During the first 2 mo, mortality was not significantly different in the hepatitis B virus–infected group (25.5%) vs. a hepatitis B virus–immune control group (21%). Beyond 2 mo, the mortality, rate of graft loss, need for retransplantation and incidence of abnormal liver function were significantly higher in the hepatitis B virus–infected group. Treatment of the hepatitis B virus infection was attempted with passive immunization, combined active and passive immunization, α‐interferon or nothing. The clinical outcome was not significantly influenced by any of these therapies. However, of the patients who lived more than 60 days, 6 of 22 treated with active plus passive immunization were cleared of HBsAg, something achieved once in 16 patients treated with α‐interferon, never in 3 patients with passive immunization only and once in 4 patients with no therapy. In patients with recurrent hepatitis B virus infection, the pace of hepatitis development in the graft appeared to be accelerated, and this was particularly striking in patients who underwent multiple retransplantations at progressively shorter intervals. None of the patients who became HBsAg‐negative had HBeAg preoperatively. (HEPATOLOGY 1991;13:619–626.)

IGIV: a potential role for hepatitis B prophylaxis in the bone marrow peritransplant period

“…7,8 Transmission of donor virus and reactivation of HBV in the recipient have in some series resulted in poor outcome. 2 In a review of 2586 BMT recipients, 24 received HBsAg+ marrow, resulting in severe liver failure and death in 21% of these patients compared to an overall 3.7% mortality rate.…”

Baboon-to-human liver transplantation

“…Infection of allografts with HBV has been recorded frequently during this time. 28 Since the baboon cannot be easily infected with HIV (if at all), 29 longer observation might have provided data about HIV status of the chimeric baboon lymphodendritic cells of monocyte/macrophage lineage, which are thought to account for the post-transplant chimerism that is invariably found after successful hepatic allotransplantation. Evidence of chimerism was widespread in the xenograft recipient's organs.…”

Lamivudine as first- and second-line treatment of hepatitis B infection after liver transplantation

“…Resistance formation as a major drawback occurred in one third of the patients within the first year of treatment. OLT Orthotopic liver transplantation rence was the most common cause of death in patients who had undergone transplantation for chronic hepatitis B [27]. Long-term passive immunoprophylaxis with anti-hepatitis B-surface immunoglobulin (HBIg) has now commonly been accepted as effective means to prevent reinfection of the graft [19].…”