LONG TERM OUTCOME OF PATIENTS WHO UNDERWENT LIVER TRANSPLANTATION FOR HEPATITIS B VIRUS INFECTION UTILIZING LOW DOSE CHRONIC HEPATITIS B IMMUNE GLOBULIN PROPHYLAXSIS.Room: 302
Nevin Yilmaz, Mitchell L Shiffman, Todd R Stravitz, Richard K Sterling, Velimir A Lucetic, Arun J Sanyal, Scott A Mills, Melissa J Contos, Daniel Maluf, Adrian Coterell, Marc P Postner, Robert A Fisher. Hepatology Section; Division of Surgical Pathology; Division of Transplant Surgery, VCU Medical Center, Richmond, VA.
Liver transplantation (LT) in patients with Hepatitis B Virus (HBV) is associated with a high rate of reinfection, graft loss and mortality unless this can be prevented with either Hepatitis B Immune Globulin (HBIG) and/or anti-viral therapy. The optimal prophylaxis regimen for eAg (+) and eAg (-) patients has yet to be defined. To help define the optimal prophylaxis regimen we conducted a retrospective study of all patients with underwent LT for HBV at our institution between 1985-2004. METHODS: The study population consisted of 51 patients; 27 eAg (+) and 19 eAg (-) prior to LT (3 patients with unknown eAg status and 2 who received less than 6 months of HBIG were excluded), 44 patients deceased donor; 2 living donor LT. All patients received HBIG as follows; 32 ml (10,000 U) IV during the anhepatic phase and post re-perfusion , then 5 ml/d (1500 U) IV 7 days thereafter 5 ml/3-4weeks IM depending on HBV Surface Ab quantitative titer. Lamivudine (LAM) or adefovir (ADV) were utilized after these agents became available. 15 eAg (+) patients received only HBIG (Group 1); 12 HBIG + either LAM or ADV (Group 2). 12 eAg (-) patients received only HBIG (Group 3); 7 HBIG + LAM or ADV (Group 4). All episodes of rejection and all HBV recurrence were confirmed histology. RESULTS: Mean age for all patients was 45 years, 87 % male and 70% Caucasion. 3 patients (6%) were co-infected with HCV; 2 (4%) with HDV, 7 (15%) had hepatocelluler carcinoma and 5 (10%) acute fulminant HBV. Mean and maximal follow-up were 5.9 and 15 years respectively. Recurrence of HBV (virologic and histologic) was 53% in Group 1 and no recurrence was developed in the other groups. Survival at 2 years was 73%, 91%, 83% and 75% in the 4 Groups respectively (p>0.05). Recurrence of HBV was significantly reduced in eAg (+) but not eAg (-) patients treated with HBIG + antiviral therapy(p=0.003).CONCLUSION: Recurrence of HBV following LT was significantly reduced in HBVeAg (+) patients receiving low dose HBIG prophylaxis + an antiviral agent. Also low dose HBIG prevented HBV recurrence in all eAg (-) patients suggesting that combination there may not be necessary in this group.
Keywords: Hepatitis B; Immunoglobulins (Ig); Lamivudine; Prophylaxis
Thursday, July 27, 2006 11:30 AM
Concurrent Session 94: Infections and Prophylaxis in Liver Transplantation: Fungal, HIV, HBV (10:30 AM-12:30 PM)