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Öğe Adefovir treatment in posttransplant hepatitis B virus infection resistant to lamivudine plus hepatitis B virus immunoglobulin(2004) Akay S.; Karasu Z.; Akyildiz M.; Tokat Y.Failure of prophylaxis for hepatitis B virus (HBV) recurrence in liver transplant patients with HBV immunoglobulin (HBIG) or lamivudine or both can be associated with rapid development of liver failure. Some of these patients develop a devastating clinicopathological state characterized by jaundice and rapidly progressive liver failure or fibrosing cholestatic hepatitis. We present two liver transplant recipients who experienced HBV recurrence while they were under lamivudine and HBIG prophylaxis. One of them had finding of severe HBV infection; the other, fibrosing cholestatic hepatitis. After commencing adefovir dipivoxil both patients showed improvements in clinical status and laboratory data. At month 4 of treatment, HBV DNA values became negative and liver function tests almost normalized. In addition, in one case showed HBs ag/anti-HBs seroconversion. When failure of prophylaxis with lamivudine and HBIG occurs, adefovir dipivoxil should be considered to be a safe and effective choice for recurrent HBV infections in liver transplant patients.Öğe Association Between Hepatitis B and Hepatocellular Carcinoma Recurrence in Patients Undergoing Liver Transplantation(2008) Kiyici M.; Yilmaz M.; Akyildiz M.; Arikan C.; Aydin U.; Sigirli D.; Nart D.; Yilmaz F.; Ozacar T.; Karasu Z.; Kilic M.Background/Aims: Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) recurrences affect both patient and graft survivals post-orthotopic liver transplantation (OLT) in HBV patients with HCC. We analyzed the relationship between HBV and HCC recurrence in a large cohort of HBV-OLT patients with versus without HCC. Methods: Two hundred eighty-seven HBV patients with OLT (72 also with HCC) were included in the study. Mean follow-up in the post-OLT period was 31.7 ± 24.7 (range, 3-119) months. Results: Post-OLT HBV recurrence observed in 10.1% of patients was more prevalent among the HCC group; 23.6% versus 5.5% in patients with and without HCC, respectively. The mean interval for the development of HBV recurrence was 39.5 ± 28.5 (range, 2-99) months. Among 72 HCC patients, 8 patients (11.1%) had recurrent HCC, and 7 of them also had HBV recurrence. The mean interval for the development of HCC recurrence was 11.2 ± 7.85 (range, 2-23) months after OLT. OLT patients with HCC with tumors exceeding the Milan criteria had worse 1-, 3-, and 5-year survival rates than patients with HCC meeting the Milan criteria. HBV and HCC recurrence-free survivals were significantly lower in patients with HCC and HBV recurrence, respectively. In the 7 patients with both HCC and HBV recurrence, mean HBV recurrence time was 9.42 ± 6.75 months and mean HCC recurrence time was 9.57 ± 6.75 months. There was a strong correlation between HBV and HCC recurrence times. Cox proportional hazards regression analysis showed that only HCC recurrence was a significant independent predictor of HBV recurrence (P < .001; hazard ratio [HR] = 26.94; 95% confidence interval [CI] = 10.81-67.11). On the other hand, HBV recurrence (P = .013; HR = 5.80; 95% CI = 1.45-23.17) and nodule count (P = .014; HR = 13.08; 95% CI = 1.70-100.83) were significant predictors of HCC recurrence. Conclusions: HBV and HCC recurrences demonstrate a close relationship in patients with OLT. © 2008 Elsevier Inc. All rights reserved.Öğe Association of TNF-? -308 polymorphism with the outcome of hepatitis B virus infection in Turkey(2008) Basturk B.; Karasu Z.; Kilic M.; Ulukaya S.; Boyacioglu S.; Oral B.Background and aim: Cytokines play important roles in the regulation of immune response. The aim of the study was to investigate the association of the cytokine gene polymorphisms with persistence of hepatitis B virus (HBV) infection and the development of end-stage liver disease (ESLD) due to HBV infection. Methods: The study involved 27 patients with end-stage liver disease due to HBV infection, 23 HBV carriers and 60 healthy controls. All genotyping (TNF-?, TGF-ß, IL-10, IFN-?) experiments were performed using sequence specific primers (PCR-SSP) by using commercial kit according to manufacturers' instructions. Results: The frequencies of TNF-? -308 G/G and TGF-ß1 codon 10-25 T/C-G/G polymorphisms were significantly higher in HBV-infected individuals (patients + carriers) when compared with those of healthy controls (p: 0.02 and p: 0.004, respectively). The frequency of TNF-? -308 G/G polymorphism was significantly higher in the patients than those of the healthy controls (p: 0.02), whereas the frequency of TGF-ß1 codon 10-25 T/T-G/G polymorphism was lower (p: 0.028). On the other hand, TNF-? -308 G/G and TGF-ß codon 10-25 T/C-G/G polymorphisms were significantly more common in HBV carriers than the control group (p: 0.017 and p: 0.018, respectively). In addition, TNF-? -308 G allele frequency was significantly more common in HBV-infected individuals (patients + carriers) than those of healthy controls (p: 0.0007). TNF-? -308 G allele frequency was also found to be higher in patients or carriers when compared with those of healthy controls (p: 0.01 and p: 0.01, respectively). Statistically significant differences were still kept after Bonferroni correction of the p-values for only TNF-? -308 G allele frequency in patients or carriers (Pc). Conclusion: Our study suggests that TNF-? gene polymorphism in patients infected with HBV would result in relatively inefficient inhibition of HBV and development of ESLD, and therefore, may be valuable predictor determinants for the development of ESLD in patients with chronic HBV infection. © 2007 Elsevier B.V. All rights reserved.Öğe Cardiovascular problems in cirrhotic patients(2004) Karasu Z.; Mindikoglu A.L.; Van Thiel D.H.Cardiovascular disease associations with chronic liver disease are identified. The effect of these cardiovascular diseases on the natural history of the underlying liver disease is considered. Their recognition and management is important in the long term care of patients with chronic liver disease, especially those being considered for liver transplantation.Öğe Cholestatic ichterus secondary to non-metastatic prostate adenocarcinoma(2000) Karasu Z.; Vardar R.; Evrengil H.; Akarca U.S.; Ersöz G.; Musoglu A.Paraneoplastic syndromes may accompany some neoplastic diseases and cause some difficulty in interpretation of signs and symptoms. Intrahepatic cholestasis is a rare clinical presentation of paraneoplastic syndromes. We report a case with prostatic adenocarcinoma whose first clinical signs presented as intrahepatic cholestasis.Öğe Colorectal Adenomateous polyps and Helicobacter pylori infection [17](Elsevier Inc., 1999) Aydin A.; Karasu Z.; Zeytinoglu A.; Kumanlioglu K.; Ozacar T.[No abstract available]Öğe Combination therapy with lamivudine and low dose hepatitis-B immune globulin against hepatitis-B recurrence after liver transplantation(2000) Gunsar F.; Tokat Y.; Karasu Z.; Akarca U.S.; Ozacar T.; Yuce G.Background/aims: Orthotopic liver transplantation, in patients with hepatitis B virus infection, is associated with a high reinfection rate. Viral breakthrough and resistance are significant problems with monotherapy with either hepatitis B immune globulin or lamivudine for prophylaxis against hepatitis B recurrence. Combination therapy with lamivudine and hepatitis B immune globulin has been suggested, but one of the most important disadvantages is the high cost of hepatitis B immune globulin. The aim of this study was to evaluate the efficacy and safety of combination therapy with low dose hepatitis B immune globulin and lamivudine for prophylaxis. Methods: Twelve patients with hepatitis B virus cirrhosis were included in the study. Three patients commenced lamivudine (150mg/daily) for HBV DNA positivity before transplantation while the remaining nine patients commenced it at the same dosage on the first day of transplantation. All patients were HBV DNA negative at the time of transplantation. Hepatitis B immune globulinwas given in our protocol as follows: 1000 IU intravenously and 1000 IU intramuscularly during the anhepatic phase of the transplantation, followed by 800 IU intramuscularly for the next two days and then 400 IU intramuscularly every other day in the first week. Four hundred IU intramuscularly was then given twice weekly while the patient was still in hospital, followed by 400 IU intramuscularly every two weeks until stabilization and followed by 400 IU intramuscularly every three weeks or month. The median duration of hospital stay was 21 days (range 14-45 days). Results: One patient died on the second postoperative day due to primary nonfunction. The remaining 11 patients were HBsAg and hepatitis B virus DNA negative for a median of 545 days (range 180-900) by polmerase chain reaction. Conclusions: Combination therapy with low dose hepatitis B immune globulin and lamivudine is highly effective against hepatitis B recurrence at a median follow up of 545 days (1.5 years). Longer follow up with more patients in multicenter prospective randomized trials will give more accurate results.Öğe Cytokine gene polymorphism and early graft rejection in liver transplant recipients(2004) Karasu Z.; Ulukaya S.; Ayanoglu H.O.; Basturk B.; Ulukaya E.; Akyildiz M.; Tokat Y.Cytokines, which play important roles in allograft rejection, show variable production among individuals. These variations may be related to genetic polymorphisms within the regulatory regions of the cytokine genes. We investigated the association between the role tumor necrosis factor alpha (TNF-?), transforming growth factor-beta (TGF-ß), interferon gamma (IFN-?), interleukin (IL)-10 and IL-6 gene polymorphisms and early graft rejection among liver transplant recipients. Forty-three liver transplant recipients enrolled in this study were divided into 2 groups based on events in the first 2 months posttransplantations, namely, those experiencing at least 1 rejection episode (n = 26) or those without any episode (n = 17). The allele or genotype frequencies of cytokine gene polymorphisms showed no difference between liver recipients with or without nonrejection. In conclusion, there was no significant correlation between early graft rejection and cytokine gene polymorphism of TNF-?, TGF-ß, IL-10, IL-6, and IFN-? in liver transplant recipients.Öğe Daily use of consensus interferon: One-year treatment results for chronic hepatitis C patients relapsing or non-responding to previous interferon(2000) Karasu Z.; Gurakar A.; Jazzar A.; Wright H.Background/aim: The optimal dose, duration and frequency of interferon treatment for chronic hepatitis C is not clear. Preliminary hepatitis C virus kinetic studies have suggested that daily interferon is more advantageous than thrice in a week administration. Recently, a synthetic recombinant interferon, consensus interferon, has been approved for clinical application. There is no data available about daily use of consensus interferon. Methods: Our study protocol was designed to investigate the efficacy of long-term (12 month) daily consensus interferon therapy for chronic hepatitis C patients, who have either relapsed or not responded to previous interferon therapy. Eleven patients were included in the study. Results: Overall, eight (72%) patients became serum HCV-RNA negative. Of these, 60% (3/5) were among previous non-responders and 83% (5/6) were among previous relapsers. Conclusions: Our preliminary data suggests that daily use of consensus interferon provides encouraging results in relapsers and non-responders. However, further time is needed to evaluate the sustained response rate.Öğe Disseminated tuberculosis with massive gastrointestinal bleeding after liver transplantation(2000) Günşar F.; Tokat Y.; Yilmaz F.; Karasu Z.; Alkanat M.; Memiş A.; Çavuşoglu C.Tuberculosis is a serious opportunistic infection in transplant recipients. We report the case of a 41 year-old woman with disseminated tuberculosis that caused massive lower gastrointestinal bleeding following orthotopic liver transplantation. The patient presented with fever of unknown origin and without any clinical signs 13 months after orthotopic liver transplantation. Liver biopsy performed for increasing alanine aminotransferase and bilirubin levels showed a granuloma, following which Mycobacterium (M) tuberculosis was determined in sputum. In the first week of antituberculous treatment, massive lower gastrointestinal bleeding occured. Angiography showed extravasation from the proximal and mid jejunum as the source of bleeding. The patient underwent surgery to control the bleeding and segmentel resection of the jejunum was performed. M. tuberculosis was also determined in the histopathologic specimens of jejunum, liver and mesenteric lymph nodes and culture of the specimens. Although bleeding stopped after surgery, the patient died from septicemia and multi-organ failure due to disseminated tuberculosis after three weeks of therapy. This is the first report of disseminated tuberculosis with massive gastrointestinal bleeding after orthotopic liver transplantation.Öğe Expression of matrix metalloproteinase-9 in predicting prognosis of hepatocellular carcinoma after liver transplantation(2010) Nart D.; Yaman B.; Yilmaz F.; Zeytunlu M.; Karasu Z.; Kiliç M.Matrix metalloproteinases (MMPs) are known to play an important role in cell migration during cancer invasion by degrading extracellular matrix proteins. This study aimed to determine the role of MMP-9 in hepatocellular carcinoma (HCC) carcinogenesis. Eighty-nine cases who underwent liver transplantation for HCC in cirrhotic liver were selected for this study. The tumor characteristics such as nodule number, maximal diameter, portal vein invasion, and the preoperative alpha-fetoprotein levels were reviewed. The intensity of immunostaining and the percentage of immunoreactive cells with MMP-9 were evaluated. All patients were evaluated for HCC recurrence and/or death, and cause of death was noted. There was a lower survival and more recurrence risk among participants with 4 or more nodules exceeding 3 cm in diameter, with poorly differentiated tumor, and with large-vessel involvement. Eleven patients developed recurrent HCC (12.4%). Twelve patients died as a result of HCC (13.5%). Among 89 HCCs, the incidences of a weak (+) and moderate (++) expression of MMP-9 in carcinoma cells were 30.3% (23/89) and 43.8% (39/89), respectively. Increased expression and intensity of MMP-9 were found to be inversely associated with poor tumor differentiation (P = 0.016, P = 0.009, respectively). A significant correlation between expression and intensity of MMP-9 and large vascular invasion (P = 0.01, and P = 0.03) was also observed. As far as prognosis is concerned, increased immunoreactivity and intensity of MMP-9 were found to exert an unfavorable impact on overall survival rates (P < 0.01, P = 0.01, respectively) and recurrences (P = 0.001, P = 0.02). Multivariate analyses revealed that MMP-9 staining percentage (P = 0.007) and portal vein invasion (P = 0.002) were independent predictors of survival, whereas the only independent predictor of recurrences was portal vein invasion (P = 0.007). In this study, our results indicate a positive association between MMP-9 expression and histopathologic parameters that indicate poor prognosis. We conclude that together, MMP-9 staining percentage and portal vein invasion in HCC may aid to predict poor outcome. Nevertheless MMP-9 staining percentage is expected to be a potential predictive marker on survival and needs to be studied more in detail. © 2010 AASLD.Öğe Gallbladder wall thickening as a sign of esophageal varices in chronic liver disease(1999) Ersoz G.; Ozutemiz O.; Akarca U.S.; Yilmaz M.; Karasu Z.; Batur Y.The etiology of gall bladder wall thickening (GBWT) in patients with cirrhosis is unknown. We aimed to compare GBWT in patients with different stages of cirrhosis and to investigate the relationship between GBWT and esophageal varices, ascites, serum albumin and transaminases levels. The patients with liver cirrhosis diagnosed were divided into three groups; from biopsy results group A was composed of 37 patients with no ascites and no esophageal varices; group B, 28 patients with esophageal varices, and no ascites without hypoalbuminemia; group C, 32 patients with esophageal varices and ascites. GBWT was 3.13±0.35 mm (mean±SD) in group A, 3.89±0.83 mm in group B and 5.00±1.39 mm in group C. There were significant differences between group A and B (p<0.0001), group A and C (p<0.0001) and group B and C (p<0.0005). Multiple regression analysis showed that esophageal varices was the only factor related to GBWT (p<0.0001). There was limited correlation between GBWT and ascites (p=0.051) and serum albumin levels (p=0.06). These results suggest that there is a close relationship between GBWT and esophageal varices. GBWT may be considered a sign of esophageal varices and portal hypertension, but a normal gallbladder wall can not rule out esophageal varices.Öğe HBV vaccination in liver transplant recipients: Not an effective strategy in the prophylaxis of HBV recurrence(2005) Karasu Z.; Ozacar T.; Akarca U.; Ersoz G.; Erensoy S.; Gunsar F.; Kobat A.; Tokat Y.; Batur Y.Anti-HBs immunoglobulins (HBIG) and lamivudine are main options to prevent hepatitis B virus (HBV) reinfection after liver transplantation. Although they are very effective, development of mutant viruses and high cost of treatment are main limitations for their application. Additionally there is an uncertainty for the duration of that prophylaxis regimen and its mostly applied indefinitely. Recently, post-transplant HBV vaccination is reported to be a cheaper alternative prophylaksis strategy, that enables discontinuation of HBIG. To investigate the efficacy of HBV vaccination in patients transplanted for HBV cirrhosis, we administered double course of double dose recombinant HBV vaccine (Genhavac B; containing HBV pre-S1, pre-S2, and S gene products). Vaccination has been started 1 month after HBIg discontinuation, and lamivudine (100 mg/day) was given throughout the study. The first cycle consisted of 0, 1- and 6-month schedule, and, in nonresponders, second cycle 0, 1-, 2-month schedule. Fourteen patients included into the study. Only one patient seroconverted (an anti-HBs titre of 37 IU/L) after the first cycle. No other patient responded to second cycle. HBV vaccination in the posttransplantation setting does not seems like an effective strategy in the prophylaxis of HBV recurrence. © 2005 Blackwell Publishing Ltd.Öğe Hepatitis B immune globulin and Hbv-related liver transplantation [Hepatit B immun globulin ve HBV nedeni ile karaciğer transplantasyonu](Marmara University, 2016) Akay S.; Karasu Z.The risk of recurrence of liver cirrhosis and hepatocellular carcinoma due to hepatitis B virus (HBV) infection was 90% following liver transplantation before 1990’s but now we rarely see recurrence due to the highly effective prophylactic treatments. In this review, we discussed the achievements of the prophylactic treatments in patients transplanted for HBV diseases. Options for hyperimmune globulin usage and high genetic barier anti-viral drugs can be used to prevent the recurrence. © 2017, Marmara University. All rights reserved.Öğe Hepatitis C virus and deep abdominal lymphadenopathy [Hepatit C virus enfeksiyonu ve derin abdominal lenfadenopati](1998) Karasu Z.; Ersoz G.; Akarca U.S.; Topalak O.; Killi R.; Batur Y.Hepatitis C virus (HCV) shares homology with flavi-and pestiviruses, which are known to infect cells of the reticuloendothelial system. HCV is able to infect and replicate within peripheral blood mononuclear cells of the host. It has been shown that HCV-related chronic liver disease is associated with B-cell lymphoproliferative disorders (i.e. mixed cryoglobulinemia and monoclonal gammopathy). Recent data suggest the existence of an association between HCV infection and non-Hodgkin's lymphoma. Enlargement of deep abdominal lymph nodes has been detected by ultrasound in various chronic liver disorders. To assess the relevance of this feature in chronic hepatitis C, we prospectively evaluated 58 patients with biopsy-proven chronic liver disease (38 chronic hepatitis C, 50 chronic hepatitis B). Ultrasonographic examination showed deep abdominal lymph node enlargement in 13% (5/38) of patients with chronic hepatitis C infection, but not in the patients with HBV (p<0.05). These results suggest that HCV might exhibit a type of lymphotropism but the clinical significance of abdominal adenopathy is still unclear.Öğe Hyperhomocysteinaemia and factor V Leiden mutation are associated with Budd-Chiari syndrome(2006) Colak Y.; Karasu Z.; Oruc N.; Can C.; Balym Z.; Akarca U.; Gunsar F.; Ersoz G.; Tokat Y.; Batur Y.OBJECTIVES: Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction and may be caused by various prothrombotic disorders. We aimed to study the role of hyperhomocysteinaemia, factor V Leiden mutation and G20210A prothrombin gene mutation in the pathogenesis of the syndrome. METHODS: Thirty-two patients (16 male, 16 female, aged 19-45 years) with angiographically verified BCS and 33 age-matched and sex-matched voluntary healthy controls (15 male, 18 female, aged 19-45 years) were included into the study. Factor V Leiden and prothrombin gene mutations were determined in extracted DNA from peripheric mononuclear cells, using a light cycler amplification system. Plasma homocysteine levels were measured by fluorescence polarization immunoassay. RESULTS: The homozygote factor V Leiden mutation was diagnosed in four BCS patients and the heterozygote mutation was diagnosed in five. The frequency of the mutant allele was 20.3% in BCS patients and 7.6% in the controls (P<0.05). There was no significant difference in prothrombin gene mutation frequency between the two groups. Serum homocysteine levels were significantly higher in the BCS group than in the controls (16.4±8.8 vs 11.0±2.7 µmol/l; P<0.01). BCS patients with the mutant factor V Leiden allele have significantly higher levels of serum homocysteine (22.1±13.3 vs 14.4±5.9 µmol/l; P<0.05). CONCLUSIONS: Hyperhomocysteinaemia, especially when associated with the factor V Leiden mutation, is an important risk factor for the development of BCS. © 2006 Lippincott Williams & Wilkins.Öğe Incidence and diagnosis of active toxoplasma infection among liver transplant recipients in Western Turkey(2008) Caner A.; Döşkaya M.; Karasu Z.; Degirmenci A.; Guy E.; Kiliç M.; Zeytunlu M.; Francis J.; Bozoklar A.; Gürüz Y.Toxoplasmosis is a serious and potentially life-threatening disease in liver transplant recipients while they are immunosuppressed. We report the clinical and laboratory findings related to active toxoplasma infection associated with 40 immunosuppressed liver transplant procedures that took place over a 12-month period at a major transplant unit in Izmir, Turkey. Twenty-seven (67.5%) of the 40 transplant recipients were found to be seropositive for toxoplasma infection and therefore at risk of reactivated infection. From the serological status of the donors, which was ascertained in 38 of 40 cases, we identified 3 (7.9%) of 38 transplants to be from a seropositive donor to a seronegative recipient. In 10 (26.3%) of 38 transplants, both the donor and recipient were seronegative, and this excluded toxoplasma as a risk. A comparison of real-time polymerase chain reaction (PCR) and nested PCR was undertaken in combination with a range of serological assays (the Sabin-Feldman dye test, enzyme immunoassay immunoglobulin M, and immunosorbent agglutination assay immunoglobulin M). Ethylene diamine tetraacetic acid blood samples from 3 of the 30 recipients at risk from toxoplasma were found positive by PCR, but only 1 of these was found positive in both assays. Among the 3 PCR-positive patients, immunoglobulin M and immunoglobulin G antibody levels increased in only 1 patient. Correlations between symptoms, laboratory findings, and clinical management (use of anti-toxoplasma therapy) are presented. Our findings suggest that toxoplasma presents a significant risk to our liver transplant population and that PCR is a helpful addition in identifying active infections and hence in informing clinical management decisions. © 2008 AASLD.Öğe The Incidence and Management of Acute and Chronic Rejection After Living Donor Liver Transplantation(2006) Yilmaz F.; Aydin U.; Nart D.; Zeytunlu M.; Karasu Z.; Kaya T.; Ozer I.; Yuce G.; Aydogdu S.; Kilic M.Living donor liver transplantation (LDLT) is a good alternative to cadaveric liver transplantation for end-stage liver disease. Herein we report the outcome of 132 LDLTs performed between 1999 and 2005, with special emphasis on the incidence and management of acute and chronic rejection. Among the LDLT population a first acute rejection episode (ARE) was clinically suspected in 24% and proven by liver biopsy in 11%. According to the Banff classification, 50% of AREs were grade 1, and 50%, grade 2. There was no grade 3 AREs. The first ARE occurred between 7 days and 23 months posttransplantation (mean 97 days, median 70 days). Ninety-seven percent (31/32) of the AREs occurred within the first year after transplantation and 3% (1/32) in the second year. Among the patients with ARE, 23% developed a second ARE between 4 and 11 months. A third ARE was detected in 8% of patients after month 18. All AREs responded to adjustment of immunosuppressive doses or steroid boluses. Chronic rejection (CR) was detected in 2%. In conclusion, the incidences of ARE and CR are consistent with the previously reported data. Acute and chronic rejections seem to be mild and easily manageable clinical conditions. Our results also showed a significant difference between clinically suspected and biopsy-proven ARE emphasizing the importance of indicated liver biopsies in the management of the LDLT population. © 2006 Elsevier Inc. All rights reserved.Öğe Interferon re-treatment for resistance to lamivudine plus interferon treatment(2003) Ersöz G.; Akarca U.S.; Günşar F.; Karasu Z.; Batur Y.Background/aims: The most important problem of the lamivudine therapy is the frequent development of drug resistance. Treatment of chronic hepatitis B patients resistant to lamivudin remains to be established. We investigated in this study the efficacy of interferon therapy for breakthrough infection to combination therapy with interferon and lamivudine. Methods: Interferon therapy was applied to nine patients who experienced HBV DNA breakthrough with ALT elevation for at least three months during the lamivudine treatment, which was given in combination with interferon for the first six months. These patients were compared with 10 patients who developed breakthrough but were not given interferon. All the patients continued to receive lamivudine. Results: Of the nine patients who were given interferon, two lost HBV DNA and had normal ALT after six months of treatment. ALT levels returned to normal in two patients who had no virological response. Of those patients not given interferon, none lost HBV DNA, but three had normal ALT at the end of the same duration of follow-up. Conclusions: The patients with breakthrough infection during lamivudine treatment, which was combined with interferon at the beginning, may benefit from another cycle of interferon treatment.Öğe Low-dose hepatitis B immune globulin and higher-dose lamivudine combination to prevent hepatitis B virus recurrence after liver transplantation(2004) Karasu Z.; Ozacar T.; Akyildiz M.; Demirbas T.; Arikan C.; Kobat A.; Akarca U.; Ersoz G.; Gunsar F.; Batur Y.; Kilic M.; Tokat Y.Post-transplant prevention of hepatitis B virus (HBV) infection is based on treatment with lamivudine and/or hepatitis B immune globulin (HBIG). However, optimum doses and duration for these drugs are not yet clear. We tested high doses of lamivudine (300 mg/day) in combination with low doses of HBIG (200-400 IU/2-4 weeks). Eighty patients who had post-transplant prophylaxis of lamivudine and HBIG were included in the study. Of those, 20 had hepatitis D virus co-infection and eight were HBV DNA-positive at the time of transplantation. Ten HBV DNA-positive patients were treated with lamivudine (150 mg/day) before transplantation; all were HBV DNA-negative after lamivudine treatment. All patients in the anhepatic phase were given 4000 IU of HBIG. Following this, 400 or 800 IU HBIG was administered intramuscularly daily for 5-10 days post-transplantation and 2-4 times weekly thereafter, according to serum titre of antibodies to hepatitis B surface antigen (anti-HBs). Lamivudine was maintained or initiated at the time of transplantation and was continued indefinitely. Median follow-up was 21 months (range 3-73 months). Recurrence of hepatitis B surface antigen (HBsAg)-positivity occurred in only three out of 78 (4%) patients; two of these three were HBV DNA-positive. Median anti-HBs titre at the final follow-up was 68 IU. Patient and graft survival was 85% at 1 year. In conclusion, a combination of lamivudine 300 mg/day and low-dose HBIG prevents post-transplantation recurrence of hepatitis B, even in the presence of viral replication in the pre-transplant period.
