Living donor liver transplantation for hepatitis B cirrhosis

The living donor liver transplantation (LDLT) experience for patients with hepatitis B virus (HBV) infection is still limited. Because LDLT can be performed electively, it can provide an appropriate length of time to reduce HBV DNA levels before the operation. This study aims to examine the feasibility of our protocol for preventing HBV reinfection after LDLT. Of 20 patients analyzed, 15 patients had detectable serum HBV DNA when referred to our hospital. Thirteen patients had hepatocellular carcinoma. All patients were treated with lamivudine (100 mg/d) before LDLT. After LDLT, hepatitis B immunoglobulin (HBIG) was administered to maintain serum antibody to hepatitis B surface antigen titers at greater than 1,000 IU/mL for 1 year and 200 IU/mL thereafter. Lamivudine was not administered postoperatively, except for three patients with detectable serum HBV DNA just before LDLT. All patients survived the operation. One patient died 229 days after LDLT of carcinoma recurrence. In the other 19 patients, liver function has remained normal and no viral relapse occurred postoperatively during a median follow-up of 19 months. Perioperative use of lamivudine and indefinite HBIG administration in the postoperative period might be a rational strategy for preventing HBV reinfection after LDLT.