Liver transplantation using hepatitis B core positive grafts with antiviral monotherapy prophylaxis

The role of hepatitis B core‐related antigen in predicting hepatitis B virus recurrence after liver transplantation

“…In the present study, we analysed the risk of HBV recurrence post‐LT in 357 HBsAg‐positive patients after LT, 48 of whom had HBV recurrence during a median follow‐up of 36.6 months (range 0.4‐107.3 months). The rate of HBV recurrence in our study was higher than the recurrence rate reported by Western researchers, but comparable to the findings of Asia‐Pacific scholars . This discrepancy in recurrence rates may be due to the fact that most subjects are infected with genotype C in the Asia‐Pacific region, which is associated with a higher risk of resistant mutants .…”

“…The rate of HBV recurrence in our study was higher than the recurrence rate reported by Western researchers, 22,23 but comparable to the findings of Asia-Pacific scholars. [24][25][26] This discrepancy in recurrence rates may be due to the fact that most subjects are infected with genotype C in the Asia-Pacific region, 27 which is associated with a higher risk of resistant mutants. 28 Multivariate Cox proportional hazards models showed that the risk of HBV recurrence in patients with HCC recurrence was considerably higher than that in patients with no HCC recurrence after LT, and that HBcrAg level was independently as- HCC is an important risk factor associated with HBV recurrence after LT in HBsAg-positive patients.…”

Liver transplantation using hepatitis B core positive grafts: Which is the optimal antiviral prophylaxis?

“…We read with great interest the article by Wong et al 1 regarding the impact of hepatitis B core antibody (anti-HBc) positive liver grafts on survival and risk of hepatitis B (HBV) infection after liver transplantation (LT). The authors evaluated 964 LT recipients who received anti-HBc positive (n = 416, 43.2%) or anti-HBc negative (n = 548, 56.8%) liver grafts.…”

“…This finding is very encouraging in the era of liver graft shortages, particularly as it did not confirm the results of a previous study 2 in which the use of anti-HBc positive liver grafts was associated with worse post-LT outcomes. The authors also evaluated the risk of de novo HBV infection after LT. 1 There were 108 HBV surface antigen (HBsAg)-negative (38 both anti-HBc/anti-HBs positive, 22 anti-HBc positive only, 24 anti-HBs positive only, 24 both anti-HBc/anti-HBs negative) recipients who received liver grafts from anti-HBc positive donors. Of them, 64 received lamivudine and 44 entecavir monoprophylaxis post-LT. De novo HBV infection, defined as post-LT detectable serum HBsAg and/or HBV DNA in HBsAgnegative recipients, was observed in 4.7% of patients under lamivudine (3/64) and none of the patients under entecavir (0/44), a numerical but not statistically significant difference (p = 0.269).…”

“…Of them, 64 received lamivudine and 44 entecavir monoprophylaxis post-LT. De novo HBV infection, defined as post-LT detectable serum HBsAg and/or HBV DNA in HBsAgnegative recipients, was observed in 4.7% of patients under lamivudine (3/64) and none of the patients under entecavir (0/44), a numerical but not statistically significant difference (p = 0.269). Based on this finding, Wong et al 1 suggested that antiviral agents with a high barrier to resistance (i.e. entecavir or tenofovir) should be used as first-line antiviral prophylaxis in HBsAg-negative recipients who receive anti-HBc positive liver grafts, in contrast to the current international guidelines which recommend lamivudine in this setting.…”