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Liver transplant recipients are at risk of developing recurrent hepatitis B after liver transplantation for hepatitis B virus (HBV)-related liver disease. We evaluated the efficacy of a new hepatitis B prophylaxis regimen involving conversion from at least 12 months of HBIg with lamivudine to combination therapy with an oral nucleoside and nucleotide analog. Between June 2008 and May 2010, a total of 61 liver transplant recipients were converted to a combination of a nucleoside and nucleotide analog. The mean (±standard deviation) follow-up time after conversion was 15.0 (±6.1) months. Recurrent HBV occurred in two (3.3%) patients at 3.1 and 16.6 months after HBIg cessation. The overall person time incidence rate for HBV recurrence after HBIg cessation was 2.7 cases per 100 person-years. The estimate of HBV recurrence was 1.7% at 1 year after HBIg cessation. HBIg cessation a minimum of 12 months after liver transplantation with subsequent combination therapy with a nucleoside and nucleotide analog provides effective prophylaxis against recurrent HBV infection. The clinical implications of HBsAg detection without clinical, biochemical or molecular manifestations of recurrent hepatitis B require further study.

A retrospective chart review of 1065 consecutive liver allograft recipients in 11 centers from January 1997 to September 1998 was performed. Patients were followed for 3 years or until graft loss. Patients received either tacrolimus (n = 594), cyclosporine (n = 450) or no calcineurin inhibitor (n = 21). Model for end-stage liver disease (MELD) scores at time of transplant were similar between the two groups. During follow-up, more patients switched from cyclosporine to tacrolimus (26.7%) than from tacrolimus to cyclosporine (12.8%; p < 0.0001). Patient and graft survival were equivalent. Corticosteroid use was more common in cyclosporine-treated patients (p < 0.00001). Patients receiving tacrolimus experienced lower serum creatinine levels at months 3 through 36 (p < 0.0001). Systolic blood pressure was lower in patients receiving tacrolimus (p < 0.001) despite a reduced requirement for anti-hypertensive agents (p < 0.0001). In addition, tacrolimus was associated with lower total cholesterol and triglyceride levels for months 3 through 24 and 3 through 12, respectively (p < 0.01), despite a reduced requirement for anti-hyperlipidemic agents. The incidence of new-onset diabetes mellitus was similar in both groups. While both calcineurin inhibitors were associated with excellent patient and graft survival, renal function, blood pressure and serum lipid levels were significantly better with tacrolimus treatment.

A large number of anesthetics, tranquilizers, hypnotic sedatives, and anticonvulsants are used clinically. Although these agents are generally well tolerated, liver injury of differing patterns is well recognized with their use. Knowledge of the likelihood of hepatotoxicity and the characteristic clinical features with these compounds is important as fatal outcomes due to liver failure have been reported with several of these agents. This article describes the potential mechanisms and clinical features of drug hepatotoxicity associated with these compounds.

Introduction: Long-term immunoprophylaxis with HBIG monotherapy reduces HBV recurrence in OLT patients, although the IV form has a number of limitations including expense and a HBV recurrence rate of approximately 20%. Combination prophylaxis with HBIG and lamivudine reduces recurrence rates further although the disadvantages of IV HBIG remain. The cost of IV HBIG has become prohibitive and thus we now report the use of 1M HBIG in maintaining adequate HBsAb titers. Methods: This was a retrospective study evaluating 49 patients transplanted between 6/93 and 8/99. Patients were treated with lamivudine, 150 mg po qd, and HBIG, 10,000 ru IV, in standard protocol (one dose intraoperatively, qd for six days, and then qmo indefinately) and then changed to 1M given as 5 ml qmo. HBsAb, HBsAg, and HBV DNA were checked monthly. Patients were changed back to IV if HBsAb levels dropped below 100 IV. All patients were continued on lamivudine. Two patients died of unrelated causes. Mean follow-up for the remaining 47 patients was 200 days (range, 40 to 353). Results: 38147 (81%) patients treated with 1M HBIG were able to maintain adequate HBsAb titers. Nine patients (19%) required intermittent IV administration for low titers or poor tolerance. No patients had recurrence of HBsAg or HBV DNA. Conclusions: 81% of patients tolerated conversion to 1M administration of HBIG with adequate HBsAb titers and without recurrence of HBV. The potential cost savings and ease of administration make 1M HBIG a viable alternative in OLT patients, Longterm follow up will determine whether 1M HBIG provides durable protection against HBV recurrence, although our initial experience suggests that excellent protection against HBV recurrence is possible. 1155