Hepatitis B prophylaxis post liver transplantation with newer nucleos(t)ide analogues after hepatitis B immunoglobulin discontinuation

Abstract

Newer nucleos(t)ide analogues (NUCs) have better resistance profiles making hepatitis B immunoglobulin (HBIG)-sparing protocol an attractive prophylactic approach against hepatitis B virus (HBV) recurrence after liver transplantation (LT). We evaluated the risk of HBV recurrence after withdrawal of HBIG in patients who had been under HBIG plus NUCs after LT. Stable patients without HBV recurrence after LT while receiving combination of HBIG plus NUCs for at least 12 months were eligible for HBIG discontinuation. The patients were at low risk for HBV recurrence (only 4.5% had detectable HBV DNA at the time of LT, and 32% had HBV/hepatitis D virus co-infection). All patients were followed up with HBV serum markers, HBV-DNA, and evaluation of renal function, including glomerular filtration rate. Forty-seven recipients discontinued HBIG and were maintained on newer NUCs. Median follow-up post-HBIG withdrawal was 24 months (range: 6-40 months). Twenty-eight (60%) patients continued on lamivudine in combination with adefovir dipivoxil (n = 23, 82%) or tenofovir (n = 5, 18%); 10 (21%) and 9 (19%) of the 47 patients continued on tenofovir and entecavir monoprophylaxis, respectively. Although 3 (6.3%) patients developed detectable hepatitis B surface antigen, all of them had undetectable HBV DNA and no clinical manifestations of HBV recurrence. Renal function was similar between the different groups of patients. In conclusion, maintenance therapy with newer NUCs after discontinuation of HBIG prophylaxis was effective, but further studies in larger cohorts with longer follow-up are needed.

High Genetic Barrier Nucleos(t)ide Analogue(s) for Prophylaxis From Hepatitis B Virus Recurrence After Liver Transplantation: A Systematic Review

“…Six studies were from USA (8,10,12,18,19,21), three from China (7,14,20), two from Spain (13,16), two from Japan (9,25) and one study from Netherlands (17), India (23), Taiwan (22) and Greece (11). Eleven studies evaluated the combination of HBIG with hgbNA(s) (7,9,10,(12)(13)(14)16,18,19,22,25), while eight studies (8,11,(17)(18)(19)(20)(21)23) evaluated patients under hgbNA(s) after HBIG discontinuation or without any HBIG (Figure 1). There was only one randomized controlled trial (10), while seven were prospective cohort (7,11,12,17,18,21,23) and nine retrospective cohort studies (8,9,13,14,16,19,…”

“…In total, 94 articles were initially identified from the literature search, but only 20 studies (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) fulfilled the inclusion criteria ( Figure A1). Of two studies (14,15) from one center in China with overlapping study periods, only the latest one (14) was included in the analysis.…”

Role of nucleoside/nucleotide analogues and low-dose hepatitis B immune globulin in prophylaxis of hepatitis B recurrence among cadaveric liver transplant recipients

“…Several studies have shown that with appropriate patient selection (high-vs. low-risk), recurrence could be minimized (26,29). The factors that impact recurrence include the presence of hepatocellular carcinoma (HCC) are LT, HCC recurrence, and types of HCC treatment (13).…”

The efficacy and safety of tenofovir in the prevention of Hepatitis B virus recurrence following liver transplantation

“…Finally, Cholongitas et al (13) found no significant differences in renal function (evaluated by GFRs using Cr-EDTA) between the group of patients under nucleotide analogues (i.e., adefovir or TDF [with or without LAM]) compared with under nucleoside analogues (i.e., entecavir monoprophylaxis) during the followup period.…”