Multicenter studies of Lamivudine for the treatment and prevention of hepatitis B after liver transplantation.

Hepatitis B is a serious liver disease that may require liver transplantation. Recurrence of the initial infection in the grafted liver occurs frequently, and this is a frequent case of death after transplantation. Treatment of recurrent infection with interferon has been ineffective, and the only therapy that has been shown to prevent infection is high dose hepatitis B immune globulin (HBIg), a material that is very expensive and in short supply. In this article the author reviews the experience with lamivudine, an orally available nucleoside analogue, as a means of preventing and treating recurrent hepatitis B after liver transplantation. The results in both areas look promising, and it is possible that lamivudine maintenance therapy may obviate the need for life-long use of HBIg after liver transplantation. This will undergo study over the next several years in a multicenter trial supported by the National Institutes of Health.