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Clinical impact and efficacy of lamivudine therapy in de novo hepatitis B infection after liver transplantation

De novo hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT) in patients negative for hepatitis B surface antigen (HBsAg) is between 1.7% and 3.5% in areas with a low prevalence of HBV infection. The importance of this problem and the efficacy of lamivudine treatment has not been defined in areas with a high prevalence of positivity to antibody to hepatitis B core antigen (Anti‐HBc). To define the characteristics and the clinical impact of de novo HBV infection in OLT recipients and to evaluate the efficacy of lamivudine treatment in this context, 229 HBsAg (−) donors (145 men, 84 women) were retrospectively evaluated between June 1994 and June 2000. Forty‐eight recipients were excluded for various reasons. The final study population included 181 patients that were prospectively followed up for more than 6 months after OLT. When de novo HBV infection was detected, liver allograft biopsy was performed and treatment with lamivudine was indicated if patients were HBV‐DNA–positive with elevated ALT levels. Survival time was defined as the interval between diagnosis of HBV infection and death or last follow‐up visit. Thirty‐one of 229 liver donors (13.5%) were anti‐HBc(+). After a mean follow‐up of 54.4±30 months, 9 of the 181 recipients (5%) developed de novo HBV infection; 8 of 27 recipients (29.6%) of livers from anti‐HBc(+) donors as compared with only one of 154 recipients (0.6%) of livers from anti‐HBc(−) donors P < 0.005). Liver biopsies performed in 8 of 9 cases showed chronic active hepatitis in 7 patients and acute hepatitis in one patient who cleared HBV spontaneously during the first 3 months. Seven patients were treated with lamivudine for a mean period of 24.5 months; HBV‐DNA became negative in 5 of 7 (71.4%), and HBeAg became undetectable in 3 of 6 patients (50%). Patient actuarial survival rates at 1, 3, and 5 years were 100%, 94.7%, and 81.2% for recipients of anti‐HBc (+) livers and 95.2%, 83%, and 77.3% for recipients of anti‐HBc (−) livers P = ns). In our area, the appearance of de novo HBV infection after OLT is related to grafting livers from anti‐HBc (+) donors is associated with a benign outcome, with no liver failure or graft loss, and treatment with lamivudine is highly effective in the control of HBV replication.