Short Course of Postoperative Hepatitis B Immunoglobulin Plus Antivirals Prevents Reinfection of Liver Transplant Recipients

Abstract

We conclude that a very short course of HBIG combined with long-term antiviral therapy is highly effective in preventing HBV recurrence and should be the preferred strategy for LT recipients with undetectable or low-level viremia at time of LT.

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

“…While many transplant centers use HBIG in addition to NAs during the early posttransplant period, transplant centers vary in the dose and duration of HBIG beyond the immediate posttransplant period. In patients at low risk for recurrence, either no HBIG or HBIG for only 5 to 7 days combined with NAs long term has been highly effective . In 42 consecutive HBsAg‐positive patients with HBV‐DNA levels <100 IU/mL at the time of transplant, prophylaxis using HBIG (5,000 IU daily) in the anhepatic phase and for 5 days postoperatively in conjunction with long‐term NA therapy prevented HBV recurrence in 97% at 3 years, with the only treatment failure being a patient with recurrent HCC (HBsAg detectable but HBV‐DNA undetectable) .…”

Approach to the patient with chronic hepatitis B and decompensated cirrhosis

“…Any patient with chronic HBV infection, either active, inactive or suppressed with antiviral therapy, who requires a liver transplant is at risk of developing HBV infection on the liver graft. This can be prevented by administering HBIG at the time of the transplantation and initiating life‐long antiviral therapy . Both TDF and entecavir can be used in liver transplant recipients.…”

Updated Hepatitis B Guidance: Implications for liver transplant patients

“…Low‐risk patients include those with acute HBV presentations and patients with low HBV DNA levels at the time of transplant. Several studies have now verified that among low‐risk patients with low or undetectable HBV DNA levels at transplant, limited posttransplant HBIG or HBIG‐free regimens in conjunction with indefinite NA treatment yield very low rates of recurrence …”