Antiviral treatment for hepatitis B virus recurrence following liver transplantation

Abstract

The purpose of this study was to identify the factors associated with the recurrence of hepatitis B virus (HBV) following liver transplantation (LT) for HBV-related disease and to recognize the outcome of treatment for HBV recurrence with oral nucleos(t)ide analogues. Six hundred and sixty-seven LTs were performed for HBsAg-positive adult patients in our institute from 1996 to 2010. HBV prophylaxis was performed by hepatitis B immunoglobulin (HBIG) monotherapy or HBIG and entecavir combination therapy. There were 63 cases (11.4%) of HBV recurrences during a median follow-up of 51 months. The median time to HBV recurrence was 22 months. A preoperative HBV DNA load of more than 10(5) IU/mL, HBIG monotherapy, and hepatocellular carcinoma in the explant liver were independent risk factors for HBV recurrence following LT in multivariate analysis. Patient survival at 10 yr was 54.2% for HBV-recurrent patients. Among patients with HBV recurrence, HBsAg seroclearance was achieved in 13 patients (20.6%), but HBsAg seroclearance did not affect survival in these patients after the recurrence of HBV (p = 0.28). The recurrence of HBV led to graft failure in six cases. HBV recurrence should be prevented by strict management of pre-transplant HBV viremia and an effective post-transplant HBV prophylaxis.

Tenofovir disoproxil fumarate rescue therapy for HBV recurrence in two liver transplant recipients with previous multiple nucleo(s/t)ide treatment failures

“…In the setting of HBV recurrence, the first-line salvage antiviral regimens always are LAM plus ADV or ETV monotherapy in our center, which is similar to other center in Asia [8]. In fact, LAM-related mutation was detectable in majority of recipients when HBV recurrence was diagnosed, which could significantly reduce the efficacy of ETV.…”

“…Although HBIG combined with NUCs (mainly LAM) after LT has been the most effective prophylaxis regimen for HBV recurrence in clinical practice until now, HBV recurrence was associated with graft loss, HCC recurrence, and significantly decreased survival rate in LT recipients [8,9]. Furthermore, recent studies have found that high preoperative HBV DNA load (>10 5 copies/ml), HBV mutation, and HCC in the explant liver were independent risk factors for HBV recurrence following LT [10].…”

Extracorporeal membrane oxygenation support for refractory septic shock in liver transplantation recipients

“…HBV prophylaxis protocol for LT recipients was combination regimen of high dose HBIG (human HBV-specific hepatitis B immunoglobulin, Greencross, Seoul, Korea) with an oral nucleotide analogue [ 12 ].…”

Immunoglobulin, nucleos(t)ide analogues and hepatitis B virus recurrence after liver transplant: A meta‐analysis

“…The only study based on a population of LT patients, including more than 1000 cases, came from Korea (n = 1524), while the sample size was above 100 cases in 13 studies. 22,29,33,[35][36][37]49,50,54,57,58,60,62,64 In the remaining 37 studies, the sample size was smaller than 100 cases.…”