Clinical

Lamivudine plus low-dose HBIG prevents post-transplant HBV recurrence

Last Updated: 2007-04-19 15:55:04 -0400 (Reuters Health)

By Martha Kerr

NEW YORK (Reuters Health) - Low doses of hepatitis B immunoglobulin (HBIG) plus lamivudine are as effective as high-dose HBIG in preventing disease recurrence in hepatitis B virus (HBV)-positive patients after they undergo liver transplantation, a report published in the April issue of Gastroenterology shows.

High-dose intravenous HBIG (approximately 10,000 IU per month) has been proven to be effective in the prevention of recurrent HBV infection, but the therapy is prohibitively expensive for many countries with endemic HBV infection.

As an alternative, Dr. Edward J. Gane and colleagues at Auckland City Hospital in New Zealand and associates in Australia studied the efficacy of one week of HBIG 400 IU or 800 IU administered intramuscularly daily plus lamivudine 100 mg daily, followed by once-a-month treatment thereafter.

The study population consisted of 147 patients who were receiving liver transplants for HBV-related end-stage liver disease. All patients received lamivudine 100 mg daily prior to transplantation for a median of 92 days.

The investigators measured serum HBV DNA before initiation of lamivudine, at transplantation and again 12 months afterward. HBV surface antigen was measured 1, 3 and 12 months after transplantation.

Prior to transplantation, 85% were HBV DNA-positive and 31% were hepatitis B e antigen-positive.

Median follow-up after transplantation was 1860 days.

Patient survival was 92% at one year and 88% at five years. Risk of HBV recurrence was 1% at one year and 4% at five years. Baseline HBV DNA titer was predictive of HBV recurrence.

Dr. Gane's team notes that low-dose HBIG plus lamivudine costs less than 10% of the cost of a high-dose HBIG regimen.

Dr. Gane told Reuters Health that, at this point, long-term treatment will be required. "Possibly in the future, stopping the HBIG and continuing lamivudine plus adefovir, or other combinations of oral antiviral drugs without cross-resistance" is a possibility, he speculated. He added that lamivudine is required to prevent resistance to adefovir.

Gastroenterology 2007;132:931-937.