Posttransplantation prevention and treatment of recurrent hepatitis B

Prophylaxis of Recurrent Hepatitis B 1. Although standard prophylaxis with antibody to hepatitis B surface antigen immunoglobulins (HBIG) is effective, it is difficult to administer and must be administered indefinitely. 2. Preemptive therapy with lamivudine reduces the early risk for recurrence after transplantation, but maintenance with either famciclovir or lamivudine has been ineffective in sustaining remission. 3. The combination of preemptive lamivudine with HBIG prophylaxis may be the most effective treatment to prevent hepatitis B virus reinfection. Treatment of Recurrent Hepatitis B 1. lnterferon-alpha, ganciclovir, and famciclovir have not been helpful. 2. Lamivudine appears promising, but its long-term efficacy is unproven; in immunosuppressed transplant recipients, the rate of emergence of YMDD mutants is high and accelerated, and their emergence is aggravated by consistent liver morbidity.