Prevention and treatment of hepatitis B relapse after liver transplantation

Objectives: To investigate the effect of orthotopic liver transplantation (OLT) on hepatitis B(HB)-related diseases and the efficiency of prevention and treatment with lamivudine on recurrence of hepatitis B posttransplant in China. Methods: Orthotopic liver transplantation (OLT) under veno-venous bypass was performed in 10, of whom 9 males had hepatitis B and 1 female had hepatocellular cancer (HCC) without HB pretransplant. Eight of the 9 males had fulminant hepatitis B (FHB) and they all had preoperative serious jaundice, ascites and coagulopathy. Six had encephalopathy; 1 was associaled with acute renal failure, and 1 with gastrointestinal hemorrhage. Seven of the 10 patients had lamivudine to prevent reinfection with hepatitis B. Results: Of the 8 patients who have survived for 2 - 12 months, 7 have survived for 6 - 12 months. Two died, one of recurrent FHB and the other from multi-organ failure (MOF). Seven preoperative HB patients of the 8 survivors have excellent liver function though 1 has positive HBsAg 6 months after OLT. One of the 8 survivors, the female with HCC pretransplant, suffered hepatitis B 6 months after OLT and her hepatic function has been gradually improving with lamivudine therapy. Conclusions: OLT is an effective therapy for certain cases of FHB and HCC and lamivudine may prevent recurrence of hepatitis B after OLT.