Prophylaxis against recurrence of HBV hepatitis after living-donor liver transplantation.

Background/aims: Although antiviral prophylaxis with the combined high-dose hepatitis B immunoglobulin (HBIg) and lamivudine therapy has effectively reduced post-liver transplantation recurrence of hepatitis B virus infection, its use is limited by cost and availability.

Methodology: Fourteen living-donor liver transplant patients were performed with the mean follow-up of the 23 months (range, 5 to 58 months). We examined the effectiveness of prophylaxis against recurrence of hepatitis B with much lower dose of HBIg. HBIg (10000 IU/day) was two or three times intra- and postoperatively administered and then the serum titers of HBIg was maintained at more than 100 IU/mL.

Results: Although two patients were preoperatively HBV-DNA positive (DNA concentrations were 4.4 and 4.7 LGE, respectively) by a transcription-mediated amplification assay (TMA) method, all 14 patients postoperatively became HBV-DNA-negative and HBsAg-negative.

Conclusions: Our protocol of the combination low-dose HBIg and lamivudine therapy prevents the recurrence of hepatitis B and is likely to be more cost-effective than high-dose HBIg regimens. Further study is needed to develop the combination therapy of the optimal dose of HBIg and lamivudine.