Prophylactic Use of Low-Dose, On-Demand, Intramuscular Hepatitis B Immunoglobulin and Lamivudine After Liver Transplantation

Karademir, Sedat; Astarcioglu, Huseyin; Akarsu, Mesut; Özkardeşler, Sevda; Özzeybek, Deni̇z; Sayıner, Ayça Arzu; Akan, Mert; Tankurt, Ethem; Astarcıoğlu, İbrahim

doi:10.1016/j.transproceed.2005.12.063

Cited by 36 publications

(32 citation statements)

References 16 publications

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“…In all, 630 articles were initially identified in the literature search, but only 56 of these articles10‐65 evaluated the rate of post‐LT HBV recurrence in patients receiving HBIG and NUCs. Because 15 studies were published from 7 centers [2 from Turkey,40, 56 2 from Germany,18, 57 7 from 3 centers in the United States,36, 37, 39, 58‐61 2 from Korea19, 62 and 2 from China54, 63] with overlapping study periods, only the latest study from each center was included in the analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, 46 studies10‐55 using HBIG and NUCs (LAM and/or ADV) were included in our analysis (Table 1). There were 3 RCTs,19, 41, 49 18 PCs,10, 12‐15, 21, 24, 26, 28, 32, 33, 42‐45, 52, 54, 55 and 25 RCs11, 16‐18, 20, 22, 23, 25, 27, 29‐31, 34‐40, 46‐48, 50, 51, 53 (Table 1). Ten of the 46 studies13, 15, 17, 20‐22, 35, 39, 45, 46 compared HBIG monoprophylaxis and HBIG‐NUC combinations, whereas data comparing NUCs and HBIG‐NUC combinations were extracted from 9 studies 23, 25, 26, 29, 32, 36, 41, 49, 55…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Hepatitis B immunoglobulin and/or nucleos(t)ide analogues for prophylaxis against hepatitis b virus recurrence after liver transplantation: A systematic review

Goulis¹,

Akriviadis²,

Papatheodoridis³

2011

Liver Transpl

109

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A combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues (NUCs) is currently recommended as prophylaxis against the recurrence of hepatitis B virus (HBV) after liver transplantation (LT), but the optimal protocol is a matter of controversy. The aim of this study was the identification of factors associated with post-LT HBV recurrence in patients receiving HBIG and NUCs. We searched MEDLINE and PubMed for studies in English about the effectiveness of HBIG and NUCs [lamivudine (LAM) and/or adefovir dipivoxil (ADV)] against post-LT HBV recurrence (January 1998 to June 2010). Forty-six studies, which included 2162 HBV LT recipients, met the selection criteria. Patients receiving HBIG and LAM experienced HBV recurrence more frequently than patients receiving HBIG and ADV with or without LAM [6.1% (115/1889) versus 2.0% (3/152), P ¼ 0.024], although they also were more frequently treated with indefinite HBIG prophylaxis (90% versus 57%, P < 0.001). For patients receiving HBIG and LAM, a lower frequency of HBV recurrence was associated with a high HBIG dosage (!10,000 IU/day) versus a low HBIG dosage (<10,000 IU/day) during the first week after LT [3.2% (14/440) versus 6.5% (80/1233), P ¼ 0.016], but the HBIG protocol had no impact on HBV recurrence in patients receiving HBIG and ADV. In conclusion, in comparison with the combination of HBIG and LAM, the combination of HBIG and ADV is associated with a lower rate of HBV recurrence after LT. Patients receiving HBIG and LAM should be given a high dosage of HBIG during the first week after LT, but a lower dosage can be used safely in patients receiving HBIG and ADV. Further studies with newer and more potent anti-HBV agents are definitely required. Liver Transpl 17:1176-1190, 2011. V C 2011 AASLD.Received April 10, 2011; accepted May 27, 2011.Despite the dramatic improvements in the treatment of patients with hepatitis B virus (HBV) over the last decade, chronic HBV infections are still associated with increased morbidity and mortality rates.1 Longterm treatment with nucleos(t)ide analogues (NUCs) results in stabilization and even improvement for most patients with decompensated HBV cirrhosis and thus significantly reduces the need for liver transplantation (LT) for HBV-induced chronic liver failure.2,3 However, hepatocellular carcinoma may still develop in patients with cirrhosis after several years of treatment-induced virological remission 4 and is currently the most common cause of LT in patients with chronic HBV.In the early 1990s, the introduction of long-term hepatitis B immunoglobulin (HBIG) use significantly reduced the rate of posttransplant HBV recurrence and improved the prognosis of patients; LT became practical for many patients with HBV-related end-stage liver

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Hepatitis B immunoglobulin and/or nucleos(t)ide analogues for prophylaxis against hepatitis b virus recurrence after liver transplantation: A systematic review

Goulis¹,

Akriviadis²,

Papatheodoridis³

2011

Liver Transpl

109

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“…With this strategy, only 4.8% of subjects experienced HBV recurrence after a median of 1.8 years of follow-up. In studies using intramuscular HBIG, given ''on demand'' to maintain trough anti-HBs titers of at least 50-100 IU/L, in conjunction with lamivudine the rates of virologic recurrence were 68.2% with follow-up periods of 3-93 months [28][29][30]. Factors associated with recurrence were higher pre-transplant HBV DNA levels, presence of lamivudine-resistant HBV, and post-transplant antibody titer.…”

Section: Alternative Hbig Dosing Strategiesmentioning

confidence: 99%

The option of HBIG-free prophylaxis against recurrent HBV

Fox

Terrault

2012

Journal of Hepatology

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Since the early 1990's, hepatitis B immune globulin (HBIG) has been central to the prevention of hepatitis B virus (HBV) recurrence after liver transplantation. When used in combination with oral nucleos(t)ide analogues, HBIG prevents reinfection with HBV in ⩾90% of transplant recipients. While HBIG is highly efficacious, its use is undermined by its high cost. Because of this limitation, there have been many studies of alternative regimens seeking to minimize the dose or duration of HBIG without sacrificing low HBV recurrence rates. Toward that goal, lower dose intramuscular HBIG in combination with oral nucleos(t)ide analogues has been shown to be highly efficacious in preventing disease recurrence and represents a significant cost savings when compared with high dose intravenous administration. The withdrawal of HBIG after a defined course of combination HBIG and oral antivirals has also been shown to be effective, particularly if combination antiviral therapy is used. The ability to achieve undetectable HBV DNA levels pre-transplantation in the majority of patients may contribute to the high efficacy of these HBIG "light" regimens. Additionally, the success of antiviral rescue therapy for those patients who fail prophylaxis and develop recurrent HBV infection post-transplant has provided the impetus to move increasingly towards HBIG-free approaches. New techniques to detect occult HBV in hepatic and extrahepatic sites may allow clinicians to define a subgroup of patients in whom withdrawal of HBIG or all prophylaxis may be applicable.

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“…More recently, similar efficacy has been shown in several studies involving low-dose HBIG protocols in combination with Lamivudine monotherapy [34][35][36][37]. In the Australian and New Zealand experience, HBIG can be used as low as 400 IU/ml, given intramuscularly, with anti-HBs titers between 50 and 100 IU/l [35].…”

Section: Lamivudine/lamivudine Plus Adefovir Plus Low-dose Hbigmentioning

confidence: 66%