Long‐term outcomes of entecavir monotherapy for chronic hepatitis B after liver transplantation: Results up to 8 years

Abstract

Long-term entecavir monotherapy is highly effective at preventing HBV reactivation after liver transplantation for chronic hepatitis B, with a durable HBsAg seroclearance rate of 92%, an undetectable HBV DNA rate of 100% at 8 years, and excellent long-term survival of 85% at 9 years. (Hepatology 2017;66:1036-1044).

Management of hepatitis B in special populations

“…This combination prevents HBV infection in ≥95% of transplant recipients [66]. Prophylaxis with NA monotherapy using drugs with a low risk of resistance with long-term use, such as ETV or TDF, also is effective [67]. However, there continue to be case reports of patients developing graft loss due to HBV infection, even in the current era of prophylaxis.…”

“…While many transplant programs use a combination of HBIG and NA therapy, some programs use NA therapy alone. The combination of HBIG plus NA therapy may be better at preventing graft infection, as reflected by presence of HBsAg post-transplant, but both HBIG plus NA and NA alone regimens achieve high success in preventing recurrent disease post-transplant [67,68]. Critical to the success of the NA alone prophylaxis strategy is the use of antivirals with a low risk of resistance with long-term use, since treatment will be indefinite.…”

“…In their transplant program, ETV (and more recently TDF) monotherapy is used as prophylaxis, with treatment started on the day of transplant and continued indefinitely. The cumulative rates of HBsAg seroclearance were 85%, 88%, 87% and 92% at year 1, 3, 5, and 8 years, respectively and 100% had undetectable HBV DNA respectively [67]. Thus, this represents an alternative prophylactic strategy and is particularly attractive due to its simplicity and lower overall costs.…”

Longterm outcome of the liver graft: A clinician's perspective—recurrent disease, the universal shifting

“…Combinations of lamivudine with high‐dose intravenous and subsequently low‐dose intramuscular HBIG used in the prophylactic setting emerged as an extremely effective strategy, and this allowed for HBV to again become an indication for LT with an acceptable longterm survival. In more recent years, and with more potent antivirals with low rates of emergent antiviral drug resistance, excellent results from strategies of longterm nucleos(t)ide analogues with either very short course HBIG or no HGIB at all have been reported . This shift has allowed transplant units to change their management protocols to prevent HBV recurrence and to effectively eliminate HBV as a cause of recurrent disease.…”

Liver transplantation and hepatitis B virus infection

“…None of these patients had histological evidence of HBV-related graft hepatitis and positive immunohistochemical staining for HBsAg [32 & ]. The concerns of the long-term efficacy of using entecavir as standalone therapy should also be alleviated by the recent results of 165 patients treated, demonstrating that the HBsAg negativity rate and HBV-DNA undetectability was sustainable, at 93.3% and 100% respectively at 7 years after liver transplantation [33]. Importantly, the overall 7-year survival was 87%, without any death related to hepatitis B recurrence.…”