Low‐dose short‐term hepatitis B immunoglobulin with high genetic barrier antivirals: the ideal post‐transplant hepatitis B virus prophylaxis?. Issue 3 (26th May 2015)

• Record Type: Journal Article
• Authors: Choudhary, N.S.; Saraf, N.; Saigal, S.; Mohanka, R.; Rastogi, A.; Goja, S.; Menon, P.B.; Soin, A.S.
• Is Part Of: Transplant infectious disease. Volume 17:Issue 3(2015)
• Page Start: 329
• Page End: 333
• Publication Date: 2015-05-26
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12369
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12369-abs-0001"> <title>Abstract</title> <sec id="tid12369-sec-0001" sec-type="section"> <title>Background</title> <p>Low‐dose hepatitis B immunoglobulin (HBIG) and nucleos(t)ides analogs (lamivudine/adefovir) used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT) are associated with some risk of HBV recurrence and antiviral resistance.</p> </sec> <sec id="tid12369-sec-0002" sec-type="section"> <title>Methods</title> <p>The study cohort included 176 patients (at least >12 months follow‐up) with HBV cirrhosis/hepatocellular carcinoma who received secondary prophylaxis with indefinite entecavir/tenofovir after living‐donor LT (LDLT). All patients received 10, 000 IU intravenous HBIG in anhepatic phase followed by 600–1000 IU intramuscularly daily for 7 days, weekly for 3 weeks, and then monthly, to keep antiHBs levels >100 mIU/mL for 1 year. Hepatitis B surface antigen (HBsAg) and HBV DNA were tested every 6 months.</p> </sec> <sec id="tid12369-sec-0003" sec-type="section"> <title>Results</title> <p>The study cohort is composed of 157 men and 19 women, mean age 47.9 ± 10.1 years, all HBsAg positive, 35 (19.8%) had HBV DNA >2000 IU/mL before LT. After LT, patients received entecavir (<italic>n</italic> = 126, 71.5%), tenofovir (<italic>n</italic> = 20, 11.3%), or a combination of entecavir and tenofovir (<italic>n</italic> = 30, 17% for 3 months), followed by entecavir alone. During follow‐up of 43 (12–117) months, 2 patients (including 1 with non‐compliance) had HBV recurrence.</p> </sec> <sec id="tid12369-sec-0004" sec-type="section"> <title>Conclusion</title> <p>In a large cohort of LDLT recipients for HBV‐related liver disease, use of low‐dose short‐term HBIG with high genetic barrier drugs results in a substantially lower incidence of HBV recurrence, even in high‐risk patients.</p> </sec> </abstract>