• Toru Ikegami, Yuji Soejima, Ryuji Ohta, Akinobu Taketomi, Tomoharu Yoshizumi, Noboru Harada, Hiroto Kayashima, and Yoshihiko Maehara.
• Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.co.jp
• Hepato Gastroenterol. 2008 Jul 1; 55 (85): 1445-9.

Background/AimsHepatic failure associated with hepatitis B virus (HBV) is one of the main indications for living donor liver transplantation (LDLT).MethodologyTwenty-nine LDLTs, including liver cirrhosis due to HBV (LC-B) (n = 17) and fulminant hepatitis B (FH-B) (n = 12) were reviewed. Prophylaxis for reinfection was performed with a combination of lamivudine, or hepatitis B immune globulin (HBIG) or adefovir, depending on the viral status. The changes in serological markers, recurrence and survival rate were examined.ResultsThere were 3 patients with re-emergencies of HBV surface antigen (HBsAg): suspension of HBIG for giving vaccination for HBV (n = 1), HBsAg positive donor (n = 1) and non-compliance for HBIG (n = 1). All patients with YMDD mutants (n = 9), except the case with HBsAg positive donor (n = 1), were successfully protected by the triple therapy of lamivudine, adefovir and HBIG. No graft loss was due to the recurrence of HBV.ConclusionThe basic strategy using a combination of HBIG and antiviral agents gave acceptable long-term outcomes for LDLT for HBV associated liver diseases. The close monitoring of HBV viral status after transplantation is still crucial in managing these patients.

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