Efficacy and effectiveness of anti-HBV therapy with early withdrawal of HBIG prophylaxis to prevent HBV recurrence following liver transplantation

Ku, Winston; Wang, Uerica; Nguyen, Mindie H.

doi:10.1517/14712598.2015.1025045

Cited by 6 publications

(2 citation statements)

References 26 publications

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“…These recent data strengthen the findings of previous studies, which supported the efficacy of antiviral monotherapy with a high‐genetic barrier NA against post‐LT HBV recurrence after HBIG withdrawal 65‐67 . However, for LT recipients with higher risk of HBV recurrence, such as patients with HBV DNA positivity at LT or HCC pre‐LT, a decision for HBIG discontinuation should be taken with great caution and after ensuring close monitoring, while further studies are needed for the evaluation of safety of HBIG discontinuation in such patients 68 …”

Section: Prevention Of Post‐lt Hbv Recurrencementioning

confidence: 98%

Antiviral prophylaxis against hepatitis B recurrence after liver transplantation: Current concepts

Orfanidou

Papatheodoridis

2021

Liver International

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The advance in treatment against hepatitis B virus (HBV) infection with the development of nucleos(t)ide analogues (NAs) with high genetic barrier to resistance, including entecavir and tenofovir, has improved clinical outcomes of patients transplanted for HBV infection, by preventing HBV recurrence after liver transplantation (LT) effectively. Currently, after LT, the combination of hepatitis B immunoglobulin (HBIG) and a high‐barrier NA is considered as the standard of care for prophylaxis against HBV recurrence. However, because of the high cost of intravenous high‐dose HBIG, other routes of HBIG administration, such as intramuscular or subcutaneous, have come to the foreground. In addition, several transplant centres tend to use a NA as monoprophylaxis, following a short post‐LT period of HBIG and NA combination. Lately, studies using HBIG‐free prophylactic regimens with entecavir or tenofovir have shown promising outcomes in preventing HBV recurrence, mostly regarding patients with undetectable HBV DNA at the time of LT. Although vaccination against HBV has been an attractive prophylactic approach, its efficacy has been controversial. Moreover, further studies are needed regarding long‐term outcomes of complete withdrawal anti‐HBV prophylaxis. For patients transplanted for HBV/HDV co‐infection, combined regimen should be administered for a longer period post‐LT. Finally, the use of grafts from hepatitis B core antibody‐positive donors is safe for HBV‐negative recipients, with the administration of lifelong antiviral prophylaxis.

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Section: Prevention Of Post‐lt Hbv Recurrencementioning

confidence: 98%

Antiviral prophylaxis against hepatitis B recurrence after liver transplantation: Current concepts

Orfanidou

Papatheodoridis

2021

Liver International

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“…Several studies have shown that LT recipients who were switched to ETV or TDF monoprophylaxis 6-12 months after commencing a combination of HBIG and ETV or TDF therapy had low rates of detectable HBV DNA levels [721,[725][726][727][728]. However, for LT recipients with a higher risk of HBV recurrences, such as patients with HBV DNA positivity at LT or HCC pre-LT, a decision for HBIG discontinuation should be taken with great caution and after ensuring close monitoring, while further studies are needed for the evaluation of the safety of HBIG discontinuation in such patients [729].…”

Section: Prophylaxis For Hbv Recurrencementioning

confidence: 99%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines. Keywords Living donor liver transplantation • Deceased donor liver transplantation • Multidisciplinary • GradeSpecial consideration: LDLT in ACLF In a study of 112 LDLT recipients with ACLF, defined by the APASL definition, post-LT outcomes were excellent (92.9% at 5 years) [69]. In a study on high-model end-stage liver disease (MELD) (score ≥ 30) LDLT recipients with ACLF (n = 190), defined by the World Congress of Gastroenterology [70], the 5-year survival rate was 72.1% [71]. In a study of 117 LDLT recipients who had ACLF, as defined by the EASL-CLIF definition, post-transplant survival after LDLT was 92.9%, 85.4%, and 75.6% at 1 year, while mortality rate without LT was 28.5%, 77.7%, and 93.4% at 90 days, for ACLF grades 1, 2, and 3, respectively [72]. These data indicate that LDLT can be a life-saving treatment option for patients with ACLF.LDLT differs significantly from DDLT, as the timing of LDLT can be determined by the transplant team. There are advantages and disadvantages of LDLT in the setting of ACLF. The benefit of LDLT in patients with ACLF is its ability to provide rapid transplantation to critically ill patients [73], without waiting for deceased donor allocation. The ideal time for LT can be selected by transplant team when willing living donor is available. If ideal time for LT can be selected in the dynamic course of ACLF, this may improve post-LT outcome. The disadvantages of LDLT include the need for healthy, willing liver donor, and the use of partial grafts for critically ill patients. A graft-to-recipient weight ratio (GRWR) is a factor associated with post-LT outcomes in LDLT [74]. The donor risk index is a factor associated with post-LT outcomes for patients with ACLF who received DDLT [66,75]. This indicates that DDLT, which uses whole liver grafts, might be a better compared to LDLT, which uses partial grafts, in ACLF. In addition, there are uncertainties regarding the criteria for living donor graft quality that is required for critically ill patients with ACLF. In studies that reported...

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A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2015 Update

Martin

Lau

Nguyen

et al. 2015

Clinical Gastroenterology and Hepatology

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Efficacy and effectiveness of anti-HBV therapy with early withdrawal of HBIG prophylaxis to prevent HBV recurrence following liver transplantation

Cited by 6 publications

References 26 publications

Antiviral prophylaxis against hepatitis B recurrence after liver transplantation: Current concepts

Antiviral prophylaxis against hepatitis B recurrence after liver transplantation: Current concepts

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2015 Update

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