Long-Term Results of Hepatitis B Immunoglobulin and Lamuvidine for Hepatitis B Prophylaxis After Liver Transplantation S. Sevmis, S. Aktas, H.H. Zia, A. Atiq, E. Akbas, H. Selcuk, H. Karakayali, and M. Haberal ABSTRACT Purpose. Recurrence of hepatitis B virus after a liver transplantation (OLT) is a risk factor affecting graft and patient survivals. Short-term hepatitis B virus reactivation rates after OLT range between 3% and 15%. Using combination prophylaxis, the outcomes of OLT among patients with liver disease related to hepatitis B virus have improved to levels comparable to those whose disease is not related to hepatitis B virus. Materials and Methods. Since September 2001, we performed 288 OLT in 282 patients including 74 who had liver failure related to hepatitis B virus among whom 58 were followed for 12 months and analyzed retrospectively. Our protocol included lamivudine (100 mg orally per day beginning the day after surgery) and hepatitis B immunoglobulin (10,000 IU IV during the anhepatic phase, 2000 IU/d IV during the first week after surgery, 2000 IU IV/month from postoperative months 1 to 12). Using our protocol, the anti-hepatitis B surface antibodies (HBsAb) serum titer was maintained up to 100 IU/mL. The female:male ratio was 11:47. The mean age of patients was 43  12.8 years. Results. Five patients died of causes unrelated to hepatitis B virus. At the time of death, their hepatitis B surface antigens were negative, and serum titers of anti-HBsAb were 45, 35.3, 56.4, 79.6, and 123 IU/mL. Mean follow-up was 46.5  18.9 months (range, 12–79). The hepatitis B surface antigen became positive in 4 patients; the remaining 49 had no evidence of hepatitis B surface antigen. In 18 patients, serum titer of anti-hepatitis B surface antigen was 0; in the remaining 31 patients, it was 69.2  133 IU/mL. Conclusion. Our combination protocol with hepatitis B immunoglobulin and lamivudine is a safe, cost-saving, and effective treatment for hepatitis B virus prophylaxis after liver transplantation. H EPATITIS B virus (HBV) infection is a common cause of liver disease worldwide. It can lead to cirrhosis, liver failure, and hepatocellular carcinoma (HCC). 1 In the United States and Europe, HBV-associated chronic or fulminant disease accounts for 5%–10% of patients transplanted every year. 2,3 HBV infection is a significant public health problem in Turkey. Almost half of the population is anti-hepatitis B core antibody (HBcAb) positive, and 5%– 8% of Turkish citizens are hepatitis B surface antigen (HBsAg) carriers. A large number of pa- tients undergoing liver transplantation (OLT) have diseases related to HBV. In the past, there has been hesitancy to transplant HBV-infected patients because of the nearly 80% rate of HBV recurrence posttransplant without appro- priate prophylaxis. 4 In 1993, Samuel et al 5 reported that early repeated use of high doses of hepatitis B immuno- globulin (HBIG) improved the survival of HBV patients transplanted with deceased donor livers. Since the wide- spread use of HBIG therapy in the post OLT period, the recurrence of HBV in the donor graft and the survival rates for HBV patients are similar to those of patients who have undergone a transplantation for other indications. 6 With the advent of lamivudine and its use in combination with HBIG posttransplant patients show further improvements From the Departments of General Surgery (S.S., S.A., H.H.Z., A.A., H.K., M.H.) and Gastroenterology, Bas ¸ kent University Fac- ulty of Medicine (E.A., H.S.), Ankara, Turkey. Address reprint requests to Mehmet Haberal, MD, FACS, FICS (Hon), FASA (Hon), Baskent University Faculty of Medicine, 1. Cad. No: 77 Kat: 4 Bahcelievler, 06490, Ankara, Turkey. E-mail: rektorluk@baskent-ank.edu.tr 0041-1345/11/$–see front matter © 2011 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2011.01.006 360 Park Avenue South, New York, NY 10010-1710 598 Transplantation Proceedings, 43, 598 – 600 (2011)