Drug Therapy Shows Promise In Preventing Hepatitis Infection In Transplant Recipients Who Receive Hepatitis B Positive Livers, Says One Study

November 05, 1998

PITTSBURGH, Nov. 5 -- Livers from hepatitis B positive donors were safely transplanted and a combination drug treatment prevented infection in recipients of those livers, a University of Pittsburgh Medical Center (UPMC) researcher will report at the 49th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) in Chicago Nov. 6-10. The results of the preliminary study are among more than 30 presentations by UPMC researchers, including three singled out by the AASLD for their scientific merits and study design.

In the face of a chronic shortage of organ donors, surgeons must often consider transplanting organs that may be considered less optimal or high risk. For example, if the only option available to save a patient's life is to transplant a liver from a donor who tests positive for hepatitis B (anti-HBc positive), a surgeon may do so even if it places the recipient at an increased risk for becoming infected with the virus. Post-transplant hepatitis B infection, which is usually evident within six months, is difficult to treat and can eventually lead to cirrhosis of the transplanted liver, thus requiring a second transplant.

But according to the UPMC study, a combination therapy of hepatitis B immune globulin (HBIG) and lamivudine has the potential to stave off post-transplant infection in patients not immune to hepatitis B who receive hepatitis B positive livers. Twelve patients who received the combination therapy, which started during the transplant operation and continued for 18 months, all continue to be free of infection between five and 25 months post-transplant, according to the study's lead author, Andrew Bonham, M.D., assistant professor of surgery at the Thomas E. Starzl Transplantation Institute. Four of these patients, who were ICU-bound before their transplants, had never been exposed to hepatitis (anti-HBs negative) and had no immunity to the virus (anti-HBc negative). Eight others, most of whom were also listed in the most urgent status categories, had previously been exposed to the virus but had not developed immunity. One patient received only HBIG therapy because in 1996, at the time of his transplant, lamivudine was not available for these patients. The patient, who had not been exposed and had no immunity, became infected with the virus six months after transplantation.

The results of the study will be presented Sunday, Nov. 8, by S. Forrest Dodson, M.D., assistant professor of surgery at the Starzl Transplantation Institute.

Three other studies being presented by UPMC researchers will be featured as AASLD President's Choice Posters. In reviewing abstracts submitted to the AASLD, a committee assigned scores to determine which ones would be accepted for poster presentation at the meeting, and those receiving scores that placed them in the top 10 percent were given the special recognition. Their results are as follows: The scientific meeting will also include a day-long series of debates on "Clinical and Administrative Controversies in Liver and Pancreas Transplantation" scheduled for Saturday, Nov. 7. The UPMC, which has strongly advocated for changes in the organ allocation system, will participate in two of three debates on this subject.

University of Pittsburgh Medical Center

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