P72 Management of chronic hepatitis B post liver transplantation: Is it time for a national consensus?. (20th September 2022)

• Record Type: Journal Article
• Authors: Mohamed, Almuthana; Greenland, Lindsay; Veloz, Maria Guerra; Beckford, Racquel; Joshi, Deepak; Aluvihare, Varuna; Suddle, Abid; Heneghan, Michael; Carey, Ivana; Agarwal, Kosh
• Is Part Of: Gut. Volume 71(2022)Supplement 3
• Page Start: A85
• Page End: A86
• Publication Date: 2022-09-20
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BASL.123
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Management of Chronic Hepatitis B (CHB) following liver transplantation includes the use of Hepatitis B Immunoglobulins (HBIG) and Nuclot(s)ides analogues (NUCs) to prevent CHB reactivation and flare. However, the duration and endpoint of HBIG remain controversial among transplant centres, and there is emerging evidence that a reduction in doses of HBIG does not adversely affect outcomes. Methods: Retrospective data were collected for all patients identified as CHB who had a liver transplant from 2015 to 2022. Key details such as Demographics, date of transplant, the reason for transplants, type of NUCs, HBIG duration and viral serology pre-transplant, 6- and 12-months post-liver transplantation were collected and analysed. Results: 45 patients were identified as CHB patients with a liver transplants. While 29 patients (64%) had CHB mono-infection, 13 (29%) had HBV/HDV Co-infection, two had HBV/HIV Co-infection, and only one patient had CHB/HDV/HIV co-infection. The median age of our study population was 49 years (Range 29–65 years) with a Male: Female ratio of 2:1. The mean estimated survival was 79.2 months (CI 95%, Range 70–88 months). 18 patients (40%) had detectable HBV DNA prior to transplant (median= 1440 Range= 11 – 6.9 E6 IU/mL). All patients were already on NUCs prior to transplant and continued on NUCs post-liver transplantation. The average number of HBIG doses in the first-week post-liver transplant was four doses per patient (Range 0–7, SD= 2 Doses). The median duration of HBIG treatment was six months, ranging from 0 to 79 months. Most of our cohort (98%) had undetectable HBV DNA at 6- and 12- months post-liver transplant. To review practice across the UK. We reviewed six transplant centres' local guidelines regarding HBIG for CHB post-liver transplant. There was a considerable discrepancy in approaches with variable doses at the first-week post-transplantation and duration ranging from no HBIG doses post-transplant to lifelong HBIG. Conclusion: This quality improvement project reports good long-term outcomes for liver transplantation in CHB patients. However, whilst NUCs and HBIG effectively prevent viral reactivation and are associated with favourable long-term outcomes; there is prolonged use of HBIG post-liver transplant that burdens the service from a cost and patient perspective. A more coherent approach to HBIG is required to guarantee optimum patient care and cost-effectiveness across transplant centres in the UK.