It acts by causing premature termination of viral DNA chains during reverse transcription. In a retrospective study, Wang et al. [37] analysed the effect of lamivudine treatment of HBV infection in 14 HTX recipients. During follow-up, 4 patients died: 1 due to end-stage liver cirrhosis, 2 due to sudden death, and another due to diffuse B cell lymphoma 14�C138 months after HTX. The patients who survived had normal liver enzymes and undetectable HBV-DNA levels but YMDD mutant occurred in 2 patients. The authors concluded that lamivudine treatment for HBV reactivation was safe and effective and may need to continue indefinitely unless a resistant mutation develops. In another pilot study, Potthoff et al. [38] assessed the efficacy of long-term antiviral therapy in 20 HTX recipients with chronic HBV infection. About 75% of patients had evidence of cirrhosis or bridging fibrosis at the start of treatment. Patients were initially treated with famciclovir and subsequently changed to lamivudine if they showed no response virologically. During the follow-up period of 103 months, only one patient was on famciclovir and 16 patients were switched to lamivudine after 0.5 to 4 years of famciclovir therapy. Of these, six patients showed long-term response to lamivudine therapy, whereas 10 patients (63%) developed resistance. Successful rescue therapy with adefovir (n = 3) and tenofovir (n = 1) was achieved in 4 of them with resistance. Nine patients died during follow-up and worryingly 5 of them were due to lamivudine-resistance-related liver failure. 5. Patient Survival/Graft Outcome in Other Solid Organ Transplantation Processes 5.1. Renal Transplantation The prevalence of hepatitis B and hepatitis C infection in end-stage renal disease (ESRD) patients is over 10% [39, 40]. The success of renal transplantation (RTx) in this cohort depends mainly on the development of future complications like rejection, neoplasm, posttransplant diabetes, and glomerulonephritis. The effect of HBV/HCV infection on patient survival/graft outcome in RTx recipients has been evaluated in a number of studies (Table 2). Table 2 Studies correlating HBV/HCV infection and clinical outcomes in other solid organ transplantation processes. In a retrospective analysis of 230 HCV infected patients, Roth et al. [15] assessed the long-term outcome of RTx in 110 patients. During follow-up, death from graft failure occurred in 15% of patients, whereas death due to other causes (with a functioning graft) occurred in 26% of patients. Death rate during the first 6 months after transplant was significantly higher as a result of infection. However, this risk was significantly lower beyond 6 months when compared with pretransplant. They also found that the liver histology remained stable or improved in 77% of RTx recipients (who underwent follow-up liver biopsies) and the 10-year patient and graft survival rate was 57 and 40%.