New nucleos(t)ide analogue monoprophylaxis after cessation of hepatitis B immunoglobulin is effective against hepatitis B recurrence

Abstract

SummaryNew nucleos(t)ide agents (NAs) [entecavir (ETV) and tenofovir (TDF)] have made hepatitis B immunoglobulin (HBIG)-sparing protocols an attractive approach against hepatitis B virus (HBV) recurrence after liver transplantation (LT). Twenty-eight patients transplanted for HBV cirrhosis in our centre were prospectively evaluated. After LT, each patient received HBIG (1000 IU IM/day for 7 days and then monthly for 6 months) plus ETV or TDF and then continued with ETV or TDF monoprophylaxis. All patients had undetectable HBV DNA at the time of LT, and they were followed up with laboratory tests including glomerular filtration rate (GFR) after LT. All patients (11 under ETV and 17 under TDF) remained HBsAg/HBV DNA negative during the follow-up period [median: 21 (range 9-43) months]. GFR was not different between TDF and ETV groups of patients at 6 and 12 months and last follow-up (P value >0.05 for all comparisons). The two groups of patients were similar regarding their ratio of maximum rate of tubular phosphate reabsorption to the GFR (TmP/GFR). In conclusion, in this prospective study, we showed for the first time that maintenance therapy with ETV or TDF monoprophylaxis after 6 months of low-dose HBIG plus ETV or TDF after LT is highly effective and safe.

Hepatitis B immune globulin and HBV-related liver transplantation

“…Subsequently, HBIG was discontinued and patients were followed for a median 21 months. Both HBsAg and HBV DNA remained negative in all patients [24].…”

Nucleoside–Nucleotide Analog Combination Therapy Is Effective in Preventing Recurrent Hepatitis B After Liver Transplantation

“…Subsequently, HBIg was discontinued and patients were followed for a median 21 months. Both HBsAg and HBV DNA remained negative in all patients [14]. In a different study, 80 patients were followed for 26-month post-transplant using entecavir monotherapy that was initiated prior to transplant.…”

“…Cholongitas et al [14] reported the efficacy of entecavir or tenofovir as monotherapy in preventing HBV recurrence in CHB patients who underwent OLT previously treated with HBIg. Eleven patients with entecavir and 17 patients with tenofovir received HBIg for 6 months.…”

“…There is a growing experience of discontinuing HBIg and substituting a second nucleos(t)ide at various periods after OLT. There are also studies looking at other combinations for HBV prophylaxis after OLT [5][6][7][8][9][10][11][12][13][14]. Four case series reported post-OLT hepatitis B surface antigen recurrence rates between 6 and 12 % in patients treated with the combination of adefovir with lamivudine [8][9][10][11].…”

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

“…Cholongitas et al studied patients who were transplanted for HBV cirrhosis and were treated with a 6-month HBIG protocol combined with either ETV or TDF as prophylaxis [20]. A total of 28 patients were enrolled into the study, with 17 of the patients treated with ETV and the other 11 with TDF.…”