Liver Transplantation for Chronic Hepatitis B in Asians

Jurim, Oded; Martin, P; Shaked, Abraham; Goldstein, Leonard I.; Millis, J. Michael; Calquhoun, S D; Gitnick, G.L.; Tong, Meiqin; Busuttil, Ronald W.

doi:10.1097/00007890-199405150-00019

Cited by 34 publications

(18 citation statements)

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“…The morbidity and mortality caused by recurrent HBV after OLT was significant before the advent of effective immunoprophylaxis. We had previously reported poor outcomes in Asian patients with chronic HBV who underwent OLT, 22 although others did not confirm this observation. 23 The present cohort of patients, including 24 Asians, was successfully protected with combination therapy and therefore has eliminated Asian ethnicity as a possible risk factor for HBV recurrence.…”

Section: Discussionmentioning

confidence: 84%

An efficacy and cost-effectiveness analysis of combination hepatitis B immune globulin and lamivudine to prevent recurrent hepatitis B after orthotopic liver transplantation compared with hepatitis B immune globulin monotherapy

et al. 2000

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Orthotopic liver transplantation (OLT) for hepatitis B virus (HBV) infectionO rthotopic liver transplantation (OLT) for hepatitis B virus (HBV) is complicated by a high rate of graft reinfection by HBV in the absence of prophylaxis. The consequences vary, ranging from asymptomatic infection with minimal graft dysfunction to fibrosing cholestatic hepatitis, graft failure, and patient death. The introduction of passive immunoprophylaxis with hepatitis B immune globulin (HBIG) post-OLT provided an initial approach to prevent recurrent HBV. [1][2][3][4][5] Despite HBIG, HBV still recurs in approximately 15% to 36% of the patients. 4,6 More recently, the advent of lamivudine, an oral purine nucleoside analogue with antiviral activity against HBV, has provided an alternative strategy to prevent recurrent HBV. Prophylaxis with lamivudine monotherapy has been shown to prevent initial HBV recurrence post-OLT. 7-9 Unfortunately, the emergence of lamivudine-resistant mutants with allograft reinfection also limits the efficacy of lamivudine monotherapy as a strategy to prevent HBV recurrence. 7,10,11 In previous studies, combination lamivudine and HBIG prevented HBV recurrence in all patients with no evidence of the development of lamivudine-resistant escape mutants during long-term follow-up. [12][13][14] In the present study, with our expanded experience in a larger cohort of patients administered combination HBIG and lamivudine to prevent recurrent HBV post-OLT, we evaluate the efficacy and cost-effectiveness of this strategy to prevent HBV recurrence compared with standard HBIG monotherapy.

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Section: Discussionmentioning

confidence: 84%

An efficacy and cost-effectiveness analysis of combination hepatitis B immune globulin and lamivudine to prevent recurrent hepatitis B after orthotopic liver transplantation compared with hepatitis B immune globulin monotherapy

et al. 2000

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“…12 A second report on 45 patients (16 Asians vs. 29 non-Asians) found that Asians had higher rates of recurrent HBV infection (72% vs. 32%, P Ͻ .05) and higher mortality rate post-LT (87% vs. 22%, P Ͻ .05). 13 A third study on 35 patients (15 Asians vs. 20 non-Asians) found that Asians had lower 1-year survival rate post-LT (59% vs. 94%, P Ͻ .05) but 5-year survival rates were similar (59% vs. 54%). 14 Poor 1-year survival rates among Asians were attributed to late referral and more advanced liver disease at transplantation.…”

mentioning

confidence: 98%

Liver Transplantation in Patients With Hepatitis B Virus Infection: Outcome in Asian Versus White Patients

Teo

Han

Terrault³

et al. 2001

Hepatology

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Previous studies have found that Asian patients transplanted for hepatitis B virus (HBV) infectionEarly studies of liver transplantation (LT) for hepatitis B reported rates of recurrent hepatitis B virus (HBV) infection of 75% and survival of 50% 2 years post-LT. 1,2 The use of hepatitis B immune globulin (HBIG) and/or lamivudine prophylaxis led to a significant reduction in recurrent HBV infection and improved survival in these patients. A study from Europe reported a recurrent HBV infection rate of 36% at 3 years with long-term use of HBIG. 1 Studies in the United States using higher doses of HBIG reported recurrent HBV infection rates of 11% to 19% at 2 years. 3,4 Lamivudine monotherapy decreased recurrent HBV infection rate to 10% to 29% at 1 year post-LT, 5,6 but recurrent HBV infection increased to 50% at 2 years because of selection of lamivudine resistant mutants. 7 Preliminary results suggest that a combination of lamivudine and HBIG may be more effective in preventing recurrent HBV infection. [8][9][10] Previous studies have found that recurrent HBV infection was related to HBV replication pre-LT and coinfection with hepatitis D (HDV). 2,11 Three early reports suggested that Asians who had LT for hepatitis B have impaired outcomes. The first study reported on 3 Asians who developed recurrent HBV infection within 2 months post-LT: all 3 died within 6 months. 12 A second report on 45 patients (16 Asians vs. 29 non-Asians) found that Asians had higher rates of recurrent HBV infection (72% vs. 32%, P Ͻ .05) and higher mortality rate post-LT (87% vs. 22%, P Ͻ .05). 13 A third study on 35 patients (15 Asians vs. 20 non-Asians) found that Asians had lower 1-year survival rate post-LT (59% vs. 94%, P Ͻ .05) but 5-year survival rates were similar (59% vs. 54%). 14 Poor 1-year survival rates among Asians were attributed to late referral and more advanced liver disease at transplantation. There were no differences in recurrent HBV infection rate (64% Asians vs. 50% non-Asians) or deaths related to recurrent HBV infection.A high percentage of patients with HBV infection listed for LT in North America are Asian. It is important to ascertain if Asians transplanted for hepatitis B have a worse outcome. We conducted a retrospective analysis of a large cohort of patients listed for LT for hepatitis B to compare the rates of pre-and post-LT survival rates and recurrent HBV infection in Asians and whites, and to identify factors that may account for any difference in their outcome. PATIENTS AND METHODSA retrospective survey was conducted in 20 LT centers across North America. Patients with hepatitis B listed for LT between January 1996 and June 1998 were included. Patients were categorized into whites (Hispanic and non-Hispanic) and Asians (Chinese, Indians, Japanese, Koreans, Pacific Islanders, and individuals born in Southeast Asian countries) and other races (American Indians including Alaskans, African Americans, etc). Baseline demographics; indications for LT; liver biochemistries; hepatitis B, C, and D serology; an...

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“…Asian race with presumed infancy or childhood acquisition of HBV was initially reported as a predictor of a poor outcome due to aggressive recurrence of HBV post-OLT. 15 However, a more recent experience suggested that this apparent association may be due to more advanced liver disease at the time of OLT rather than any unique effect of race, 16 and a recent update has indicated again no adverse effect on HBV recurrence due to race. 17 (Table 1).…”

Section: Predictors Of Hbv Recurrencementioning

confidence: 99%

Hepatitis B and C in the Liver Transplant Recipient

Rosen

Martin

2000

Semin Liver Dis

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Liver disease related to chronic viral hepatitis is the leading indication for orthotopic liver transplantation (OLT) worldwide. The evolution of our understanding of hepatitis B and C infection in the OLT recipient has been rapid in the last decade. The spontaneous risk for viral recurrence after transplantation is high but has been effectively decreased in hepatitis B infected recipients with the use of HBIG and lamivudine with dramatic improvements in patient and graft survivals. HCV recurrence as defined by histologic injury is almost universal although graft or patient outcomes for the first decade after OLT do not appear to be limited by HCV infection for most patients. However, individual patients do suffer severe graft injury and even graft loss due to recurrent HCV. With longer follow up into the second decade, the prevalence of HCV-related graft failure is likely to increase. In addition, the role of different immunosuppressive protocols on disease recurrence requires further study. Thus, although hepatitis B recurrence has been effectively contained by use of HBIG with or without lamivudine, the more intractable problem of managing recurrent HCV has as yet no obvious solutions. Optimal antiviral strategies for hepatitis C post-OLT have yet to be identified.

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Liver Transplantation for Chronic Hepatitis B in Asians

Cited by 34 publications

References 0 publications

An efficacy and cost-effectiveness analysis of combination hepatitis B immune globulin and lamivudine to prevent recurrent hepatitis B after orthotopic liver transplantation compared with hepatitis B immune globulin monotherapy

An efficacy and cost-effectiveness analysis of combination hepatitis B immune globulin and lamivudine to prevent recurrent hepatitis B after orthotopic liver transplantation compared with hepatitis B immune globulin monotherapy

Liver Transplantation in Patients With Hepatitis B Virus Infection: Outcome in Asian Versus White Patients

Hepatitis B and C in the Liver Transplant Recipient

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