Since the early 1990s, therapeutic options for patients undergoing liver transplantation for hepatitis B have evolved to include HBV immune globulin (HBIG) and lamivudine.
At the same time, the outcomes for liver transplant recipients with hepatitis B improved dramatically, as detailed in a new study published in the August 2004 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS).
Liver Transplantation is published on behalf of the societies by John Wiley & Sons, Inc., and is available online via Wiley InterScience.
Before the arrival of HBIG and lamivudine, people with hepatitis B were poor candidates for liver transplantation, because the virus almost always infected and destroyed their new organ. Then therapeutic innovations arrived. In the early 1990s in the United States, HBIG became widely used after being shown to significantly reduce the incidence of recurrent hepatitis B. In 1995, lamivudine was found to be effective against hepatitis B. Most recently, new antiviral agents like adefovir may help patients whose hepatitis B is resistant to other therapies.
In light of these innovations, researchers, led by W. Ray Kim, M.D., of the Mayo Clinic, examined 15 years of data on outcomes after liver transplantation for recipients with hepatitis B-related liver disease. The researchers hypothesized that these patients' survival would have improved over time, more than that of transplant recipients with other diagnoses, likely due to the therapeutic advances.
The researchers used data from the United Network for Organ Sharing (UNOS) for all adults receiving transplants between 1987 and 2002. They divided the data into three time frames: Era 1(1987-1991) when no prophylaxis was routinely used; Era 2 (1992-1996) when HBIG was used alone; and Era 3 (1997- 2002) when both HBIG and lamivudine were used together. They collected information on each patient's diagnosis and survival after transplant and used statistical analyses to compare survival between groups. They also analyzed demographic and other data such as age, race and ischemic times.