Prevention of recurrent hepatitis B virus infection after liver transplantation: hepatitis B immunoglobulin, antiviral drugs, or both? Systematic review and meta-analysis

Abstract

Combination treatment with HBIg and LAM reduced HBV recurrence following liver transplantation, compared with HBIg or LAM alone, and reduced mortality compared with HBIg alone.

Identification of HBsAg-specific antibodies from a mammalian cell displayed full-length human antibody library of healthy immunized donor

“…3,4 Hepatitis B immunoglobulin (HBIG) is also important in the management of HBV infection. 5,6 Since vertical transmission is responsible for about 40%-50% of HBV carriers, 5 newborns of mothers who are HBV surface antigen (HBsAg)-positive are generally required to receive HBIG and hepatitis B vaccine within 24 h following delivery and complete the whole regimen of recommended vaccination injections. 7 Liver transplantation is an effective method for end-stage liver disease management, and many people with liver diseases related to HBV receive liver transplantation.…”

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“…20 The combination of HBIg and NAs is more effective against HBV reinfection after liver transplant than HBIg alone, because of synergistic activity; the combination results in a greater reduction in the needed time course and doses of HBIg. 11,21 The combination of HBIg and lamivudine has been the standard of care recommended by many centers against HBV reinfection, with recurrence rate of less than 10% at 2 years after liver transplant. 22 However, there is an increasing interest among liver transplant centers in using more potent NAs, such as adefovir, tenofovir and entecavir, instead of lamivudine.…”

“…9,10 Hepatitis B immunoglobulin prophylaxis in combination with the nucleoside/nucleotide analogs (NAs) lamivudine or tenofovir is a well-accepted treatment recommended by many centers for prevention of HBV reinfection after liver transplants. 11 However, there is no consensus on a standard prophylactic method, and controversy over the duration, dose, and route of administration of HBIg exists among transplant centers.…”

Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation

“…Besides producing significant costs, longterm HBIg monotherapy may promote the development of viral mutations [62,63] . Therefore, a combination of HBIg with potent nucleos(t)ide analogues (NA) is considered as gold standard in prophylaxis of recurrent HBV [62][63][64][65][66][67] . Currently, the combination of anti-HBs Ig with tenofovir or entecavir is under clinical evaluation [62,68] .…”