Preoperative lamivudine therapy in HBV DNA positive recipients: is it always necessary?

Background/aims: Long-term preoperative lamivudine therapy has been recommended for patients with positive HBV DNA to suppress HBV replication before liver transplantation. However, it is unclear whether preoperative lamivudine therapy is mandatory in HBV DNA positive patients to reliably prevent HBV recurrence or whether transplantation should be delayed to allow time for sufficient preoperative lamivudine therapy.

Methodology: From January 2000 to January 2004, thirty-eight patients serum positive for HBV DNA who survived more than 3 months after transplantation and received postoperative combination prophylaxis with hepatitis B immune globulin and lamivudine were enrolled.

Results: Total 2-year recurrence rate was 8.7%. When these 38 patients were divided into two groups according to preoperative lamivudine therapy duration: group 1 (n = 11) 4 weeks or more and group 2 (n = 27) less than 4 weeks, recurrences were detected in 3 (27.2%) and 4 (14.8%) patients in groups 1 and 2, respectively, i.e. a similar recurrence rate in both groups (p = 0.390). Moreover, in a subgroup of 20 patients who received preoperative lamivudine therapy for less than one week, only one (5%) experienced HBV recurrence.

Conclusions: Our findings indicate that postoperative combination prophylaxis is effective and that preoperative lamivudine therapy is unlikely to be obligatory despite a positive preoperative serum HBV DNA status.