Living donor liver transplantation for hepatitis B associated liver diseases: a 10-year experience in a single center
Ikegami, T.; Soejima, Y.; Ohta, R.; Taketomi, A.; Yoshizumi, T.; Harada, N.; Kayashima, H.; Maehara, Y.
Hepato-Gastroenterology 55(85): 1445-1449
2008
ISSN/ISBN: 0172-6390 PMID: 18795708 Document Number: 617816
Hepatic failure associated with hepatitis B virus (HBV) is one of the main indications for living donor liver transplantation (LDLT). Twenty-nine LDLTs, including liver cirrhosis due to HBV (LC-B) (n = 17) and fulminant hepatitis B (FH-B) (n = 12) were reviewed. Prophylaxis for reinfection was performed with a combination of lamivudine, or hepatitis B immune globulin (HBIG) or adefovir, depending on the viral status. The changes in serological markers, recurrence and survival rate were examined. There were 3 patients with re-emergencies of HBV surface antigen (HBsAg): suspension of HBIG for giving vaccination for HBV (n = 1), HBsAg positive donor (n = 1) and non-compliance for HBIG (n = 1). All patients with YMDD mutants (n = 9), except the case with HBsAg positive donor (n = 1), were successfully protected by the triple therapy of lamivudine, adefovir and HBIG. No graft loss was due to the recurrence of HBV. The basic strategy using a combination of HBIG and antiviral agents gave acceptable long-term outcomes for LDLT for HBV associated liver diseases. The close monitoring of HBV viral status after transplantation is still crucial in managing these patients.