|
KMID : 0870419980020020081
|
|
Korean Journal of Hepato-Biliary-Pancreatic Surgery
1998 Volume.2 No. 2 p.81 ~ p.86
|
|
|
Orthotopic Liver Transplantation in HBs-Antigen Positive Patients
|
|
Cho Jae-Won
Park Yeon-Ho
Kim Sung-Ju
Choi Seong-Ho
Lee Suk-Koo
Lee Joon-Hyeok
Koh Kwang-Cheol
Paik Seung-Woon
Kim Yong-Il
Lee Byung-Boong
|
|
|
Abstract
|
|
|
Background/Aims: Orthotopic liver transplantation (OLT) for end-stage liver disease caused by hepatitis B virus (HBV) infection is still controversial because of the high risk of reinfection of the graft with HBV, which can lead to graft
failure, death or retransplantation. The risk of HBV recurrence appears greater in patients with detectable HBV replication before transplantation. Long-term unlimited administration of anti-hepatitis B surface (HBs) immunoglobulin (Ig) has been used to prevent reinfection of the graft. Lamivudine, a nucleoside analog with potent anti-viral effects against hepatitis B is administered in some centers. We reviewed our experiences with OLT for HBsAg positive patients to analyze the efficacies of anti-HBs Ig and lamivudine on HBV reinfection.
Materials and Methods: From May 1996 to Feb 1998, 18 orthotopic whole liver and one living-related partial liver transplantation were performed to 19 HBsAg-positive end-stage liver disease patients at our hospital. Among them, 14 patients were followed up at least three month (range: 3-24 months). The prophylactic protocol to prevent HBV reinfections consisted of two groups. For one group, anti-HBs Ig (HEPA-BIG , Green Cross Pharmacy, Seoul, Korea) was given intravenously, 8 patients. Another group that received lamivudine was given 150㎎/day orally for preoperatively, 6 patients HBV-DNA and serological markers were checked in 14 patients surviving more than 90 days after transplantation, with follow up ranging from three month to twenty foul months. In anti-HBs Ig group, these were four HBY-DNA negative and positive patients, respectively Lamivudine group was consisted of three HBV-DNA negative and three HBV-DNA positive patients.
Results: One week after OLT, all these patients became HBsAg negative and anti-HBs antibody positive with the serum titer more than 1000 IU/ℓ. Eight patients whose viral replication was active before transplantation converted to seronegative status. At present, fourteen survivors are showed HBV-DNA negative and HBsAg negative in serum, regardless of preoperative HBV-DNA status.
Conclusion: The unlimited immunoprophylaxis with anti-HBs Ig produced a fairly good result in the prevention of HBV recurrence and lamivudine was also a beneficial and well-tolerable therapy in OLT patients with HBV infection in short term follow-up periods. Although the precism effectiveness of our protocols need longer Periods of studies , the Preoperative HBV-DNA positive status was not considered to be an absolute contraindication for OLT.
|
|
|
KEYWORD
|
|
|
Hepatitis B virus infection, Anti-HBs immunoglobulin, Lamivudine
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
  
|
|