A Clinic Study Of Prophylaxis Of Patients' Hepatitis B Virus Recurrence After Liver Transplantation Using Hepatitis B Immunoglobulin Combined With Oral Lamivudine

ObjectiveTo discuss the effect of prophylaxis of patients' Hepatitis B virusrecurrence after liver transplantation using Hepatitis B Immunoglobulincombined with oral LamivudineMethodsIntravenous HBIG was applied during early 6 months after LT whileintramuscular HBIG combined with Lamivudine orally was applied 6 months postoperatively in 55 patients. Hepatitis B serum markers, HBsAg,Anti-HBs, HBeAg, Anti-Hbe, HBcAg and Anti-HBcAb and were detectedevery week in the first month by immunohistochemistry, then each month.Serum HBV-DNA wes examined by PCR at the same time of abovedetection. Liver biopsy was conducted to the doner livers during operationand to the transplanted livers postoperatively in regular interval. HBsAgand HBcAg in the liver specimens were examined byimmunohistochemistry. YMDD mutation sequence was investgated tothose patients with conversion of positive HBV-DNA postoperatively.ResultsThe positive rates were 100%, 18.18%, and 54.55% for the serumHBsAg, HBeAg, and HBV-DNA of the patients respectively before LT.Hepatitis B recurrence rates were 12.7%,14.7% and 17.9% in 3 mouths, 12mouths, 18 mouths after LT respectively. Average recurrence time was96.56+120.37d. HBV-DNA had been positive in 8 out of the 9 cases withpostoperative recurrence, and positive in 22 out of the 46 cases withoutrecurrence (P=0.026). HBeAg had been positive in 5 out of the 9 cases withpostoperative recurrence, and positive in 10 out of the 46 cases withoutrecurrence (P=0.034). HCC had been in 5 out of the 9 cases withpostoperative recurrence, and positive in 18 out of the 46 cases withoutrecurrence(P-0.394). HBV-DNA in 6 patients who were positivepreoperatively, converted to negative after LT and then back to positive.The mutation of YMDD locus (YMDD→YIDD or YMDD→YVDD) had beenfound in 2 of the 6 cases. ConclusionIntravenous HBIG was applied during early 6 months after LT whileintramuscular HBIG combined with Lamivudine orally, 100mg/day, wasapplied 6 months postoperatively is effective against HBV recurrence afterLT. Positive HBV.DNA and HbeAg preoperatively were the high risks ofrecurrence of HBV. In the patients given the Lamivudine, HBV recurrencecauses the mutation of YMDD locus on the HBV-DNA polymerase gene. Tothose patients with HBV related diseases, replication of HBV should becontrolled possiblely and HBV.DNA and/or HbeAg should been convertednegetively before LT in order to prevent HBV recurrence.