Does pre-liver transplant HBV DNA level affect HBV recurrence or survival in liver transplant recipients receiving HBIg and nucleos(t)ide analogues?

Campos‐Varela, Isabel; Castells, L.; Buti, Marı́a; Vargas, Vı́ctor; Bilbao, Itxarone; Rodríguez‐Frías, Francisco; Jardí, Rosendo; Charco, R.; Guàrdia, J; Esteban, Rafael

doi:10.1016/s1665-2681(19)31567-4

Cited by 17 publications

(10 citation statements)

References 35 publications

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“…The administration of low dose intramuscular (IM) HBIg has been discussed as an accepted alternative route to IV administration in several studies worldwide (Table 1)[2][3][14][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. However, given the limited volumes that can be given per IM injection, only patients with low HBIg requirements are suited for IM HBIg administration [9][53].…”

Section: Resultsmentioning

confidence: 99%

“…In several studies, administration of HBIg at low doses (300-800 IU) through the IM rather than the IV route has been shown to reduce the cost of prophylactic therapy, making the low-dose protocol as effective as the high-dose protocol [7][8][14][19][38][39][41][42][43][44][45][46][47][48][49][50][51][59][63] (Table 1). As a result of the combination with lamivudine, this approach was associated with similar recurrence rate and survival [40][42] that could effectively prevent HBV recurrence after liver transplantation [2].…”

Section: Resultsmentioning

confidence: 99%

“…Currently, this approach is being employed in many transplant centers in the United States, despite a lack of significant differences between the different HBIg regimens in terms of HBV recurrence 5 years after LT [65]. Although compared to other treatments, indefinite, high dose HBIg treatment combined with NAs is thought to be very effective, the cost of this treatment is very high and as a result, in recent years, several centers have preferred to use short-term HBIg treatment in combination with indefinite nucleos(t)ide analogue therapy (Table 1) [6][8][38]. Moreover, indefinite combination therapy with HBIg and a NA may not be required in all liver transplant recipients.…”

Section: Resultsmentioning

confidence: 99%

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Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

Dindoost

Jazayeri

Alavian³

2012

Hepat Mon

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ContextLiver transplantation is the best treatment option for end-stage liver disease following hepatitis B (HBV) infection. However, the high rate of recurrence of HBV infection following transplantation is a disadvantage of this option.Evidence AcquisitionOver the past 2 decades, the gold standard of prophylactic treatment for the prevention of HBV re-infection following liver transplantation has been the administration of low- to high-dose hepatitis B immune globulin (HBIg) along with an antiviral agent to induce passive immunity.ResultsThe effectiveness of HBIg in preventing the recurrence of HBV depends on the dosage, route of administration, and duration of HBIg treatment, and the viremic status at the time of transplantation. There is currently no consensus on a standardized recommendation for therapeutic options that include HBIg administration.ConclusionThis review attempts to summarize the available data on the feasibility of such options. Most recent studies support the use of long-term combination therapy of HBIg and antiviral NAs (especially new agents).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

Dindoost

Jazayeri

Alavian³

2012

Hepat Mon

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“…Of the patients who developed HBV recurrence in their cohort, a high proportion, 47% (9/19 patients), were found to have the YMDD (also called the M204V/I or LAM resistance) mutation, which was probably the major reason for HBV recurrence. Other smaller studies [12] have also been unable to find an association between HBV DNA levels and HBV recurrence and survival, but this may be due to the limitations of a small sample size and pre-existing treatment bias from including patients who were transplanted during an era prior to the availability of LAM.…”

Section: Pre-transplant: Predictors Of Post-lt Outcomesmentioning

confidence: 98%

Hepatitis B and Liver Transplantation: Update in Management before and after Transplantation

Chang

Brown

2011

Curr Hepatitis Rep

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Patients who undergo liver transplantation (LT) for chronic hepatitis B virus (HBV) infection are at high risk of developing recurrent HBV in the absence of effective prophylaxis. Pre-LT management should focus on suppression of HBV DNA levels, which have been associated with HBV recurrence. Evidence linking hepatocellular carcinoma (HCC) recurrence to HBV recurrence has been less clear. Prophylaxis against recurrent HBV after LT with combination HBIG and antiviral therapy is the current standard of care and is effective in >90% of patients, but investigation is ongoing to determine the most cost-effective treatment regimens. While antiviral therapy with newer nucleos(t)ide analogues without HBIG is assumed to be effective, no recent studies have examined the long-term efficacy of salvage regimens for recurrent HBV. Large, prospective trials are urgently needed. Overall, LT for HBV is highly effective with appropriate pre-and post-LT antiviral therapy.

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“…We discourage the use of lamivudine in this setting. Patients with high serum HBV DNA levels regardless of their HBe Ag status and patients with antiviral drug-resistance prior to transplant are considered at high-risk of post-transplant HBV recurrence (20). In conclusion, viral suppression induced by antivirals results in a clinical improvement which may allow liver transplantation to be delayed or even avoided.…”

Section: Management Of Hbv Infection In Patients With Cirrhosis Bementioning

confidence: 99%

Management of Hepatitis B Virus Infection in Liver Transplantation Setting; The Rising Concerns and Growing Hopes, Report From 10th Congress of the Iranian Society for Organ Transplantation, 2011, Shiraz, Iran

Alavian¹,

Lankarani

Rizzetto

et al. 2012

Hepat Mon

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Hepatitis B infection is the main cause of liver related mortality in many countries including Iran. Liver transplantation in cirrhosis due to HBV infection before 1990 was an absolute contraindication. Recurrent infection was a significant event in post liver transplant setting and resulted in increased risk of graft failure and death except successful transplanted individuals. Advances in antiviral prophylaxis have now made graft reinfection majority patients as a rare event. Graft and patient survival have been improved significantly during the past two decades, and consequences of transplantation for hepatitis B virus are now superior to those achieved for most other indications. This has encouraged many centers including the major liver transplantation center of Iran, in Shiraz, to provide liver transplantation to more patients with HBV related end stage liver disease. Management of these patients begins before transplantation along with special care after transplantation. There are some myths and doubts in the management of these patients and one should always balance the cost and efficiency. One of the major concerns is the high economic and social cost of recurrence and all possible efforts should be performed to avoid the ominous consequences of reinfection. Having a clear scientific grasp on the management of HBV cirrhosis before and after liver transplantation, options and protocols, and changing the concept which HBV infected are contraindicated ones for liver transplantation, and future hopes in increasing patients survival after liver transplantation using the new nucleosides analogues and availability of hepatitis B immunoglobulin in the transplantation setting. This scientific report paper outlines the insights communicated at the HBV and liver transplantation symposium during 10th Congress of the Iranian Society for Organ Transplantation, May 2011, Shiraz, Iran.

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Does pre-liver transplant HBV DNA level affect HBV recurrence or survival in liver transplant recipients receiving HBIg and nucleos(t)ide analogues?

Cited by 17 publications

References 35 publications

Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

Hepatitis B and Liver Transplantation: Update in Management before and after Transplantation

Management of Hepatitis B Virus Infection in Liver Transplantation Setting; The Rising Concerns and Growing Hopes, Report From 10th Congress of the Iranian Society for Organ Transplantation, 2011, Shiraz, Iran

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