Shorter hepatitis B immunoglobulin administration is not associated to hepatitis B virus recurrence when receiving combined prophylaxis after liver transplantation

Lens, Sabela; García‐Eliz, María; Fernández, Inmaculada; Castells, L.; Bonacci, Martín; Mas, Antoni; Crespo, Gonzalo; Buti, María; Prieto, M.; Forns, Xavier

doi:10.1111/liv.13858

Cited by 15 publications

(14 citation statements)

References 29 publications

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“…Twenty‐seven of 33 HCC patients with HBV recurrence also had HCC recurrence or metastasis. We found that HCC recurrence after LT was also significantly associated with HBV recurrence (HR 7.58, 95% CI 4.15‐13.84, P < .001), supporting the notion that increased virus production in recurrent HCC acts as a reservoir for HBV recurrence . Recurrent HCC after LT should be monitored closely because such patients have a relatively high risk of HBV recurrence.…”

Section: Discussionsupporting

confidence: 70%

“…Therefore, there were no significant differences among the various antiviral agents. Second, because there were only two patients co‐infected with HCV and had no HBV recurrence during the follow‐up, the effect of co‐infection on HBV recurrence could not be analysed, even though co‐infections have been reported to increase the risk of HBV recurrence . Third, the results were established based on a Chinese population, and their applicability to Western populations must be separately evaluated.…”

Section: Discussionmentioning

confidence: 99%

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The role of hepatitis B core‐related antigen in predicting hepatitis B virus recurrence after liver transplantation

Liu

et al. 2019

Aliment Pharmacol Ther

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Summary Background Hepatitis B core‐related antigen (HBcrAg) is a viral marker for the development of cirrhosis and hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, the relationship between HBcrAg and HBV recurrence after liver transplantation (LT) is unclear. Aim To investigate the correlation of serum HBcrAg level with HBV recurrence post‐LT to evaluate the prognostic role of the pre‐LT HBcrAg level. Methods This retrospective cohort study enrolled 357 CHB patients who received LT for a median of 36.6 months. Univariate and multivariate analyses and time‐dependent receiver operating characteristic (ROC) curves for markers associated with HBV recurrence were analysed. Results 48 patients (13.4%) had HBV recurrence after LT. HBcrAg, detectable HBV DNA, HCC and HCC recurrence were associated with HBV recurrence. In a multivariate analysis, HBcrAg level was independently associated with HBV recurrence, and the relationship between HBcrAg level and incident HBV recurrence was significant and graded (HR: 3.17 per unit; 95% CI: 1.97‐5.11; P for trend < .001). Additionally, HBcrAg level was superior to HBV DNA level in predicting HBV recurrence by time‐dependent ROC analysis. Patients with an HBcrAg ≥ 5.0 log U/mL had a significantly higher 5‐year cumulative recurrence rate than those with an HBcrAg < 5.0 log U/mL (37.6% vs 6%, P < .001); the adjusted hazard ratio was 5.27 (95% CI 2.47‐11.25, P < .001). Conclusion An elevated serum HBcrAg level was independently associated with the risk of HBV recurrence in patients with CHB after LT.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

The role of hepatitis B core‐related antigen in predicting hepatitis B virus recurrence after liver transplantation

Liu

et al. 2019

Aliment Pharmacol Ther

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“…Bei Vorliegen dieser Risikofaktoren sollte man derzeit von einem Absetzen der HBIG-Therapie Abstand nehmen. Diese Empfehlungen stützen sich unter anderem auf retrospektive Analysen von 338 Patienten, bei denen sowohl eine präoperative Lamivudin-Resistenz als auch ein HCC signifikant mit einem erhöhten HBV-Rekurrenzrisiko nach Beenden der kombinierten Prophylaxe assoziiert waren [247].…”

Section: Kommentarunclassified

S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) zur Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion – (AWMF-Register-Nr. 021-11)

et al. 2021

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Das methodologische Vorgehen ist im Leitlinienreport dargelegt. Dieser ist im Internet z. B. unter www.dgvs.de/wissen-kompakt/ leitlinien/leitlinien-dgvs/ oder https://www.awmf.org/leitlinien/ detail/ll/021-011.html frei verfügbar. Schema der EvidenzbewertungDie Literaturbewertung wurde nach der Evidenzklassifizierung des Oxford Centre for Evidence-based Medicine 2009 (▶ Tab. 2) durchgeführt und in den Kommentartexten entsprechend angegeben. In den Empfehlungen wird für die Übersichtlichkeit auf die detaillierte Klassifizierung verzichtet und lediglich von 1 bis 5 angegeben. Die Details zur Suche und Auswahl und Bewertung der Evidenz sind im Leitlinienreport dargestellt. Schema der EmpfehlungsgraduierungBei der Überführung der Evidenzstärke in die Empfehlungsstärke konnte der Empfehlungsgrad gegenüber dem Evidenzgrad aufoder abgewertet werden (s. ▶ Abb. 1). Die Graduierung der Empfehlungen erfolgte außerdem über die Formulierung soll, sollte, kann (▶ Tab. 3).Negative Empfehlungen werden entsprechend formuliert. Die Konsensusstärke wurde gemäß ▶ Tab. 4 festgelegt. StatementsAls Statements werden Darlegungen oder Erläuterungen von spezifischen Sachverhalten oder Fragestellungen ohne unmittelbare Handlungsaufforderung bezeichnet. Sie werden entsprechend der Vorgehensweise bei den Empfehlungen im Rahmen eines formalen Konsensusverfahrens verabschiedet und können entweder auf Studienergebnissen oder auf Expertenmeinungen beruhen. Bei allen Statements wurde auf die Vergabe des Empfehlungslevels verzichtet. Hintergrundinformationen wurden im Erläuterungstext dargestellt.

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“…For low‐risk patients, lower HBIG doses and discontinuation of HBIG became possible provided patients continued on third generation NA long‐term (Table 2). 42‐56 The type of prophylaxis in low‐risk patients (combined short‐term HIBG + NA vs NA monotherapy with no HBIG) was extensively discussed amongst the panel. Pros and cons of both strategies are summarised in Table S2.…”

Section: Search Strategy; Selection Criteriamentioning

confidence: 99%

2020 position statement and recommendations of the European Liver and Intestine Transplantation Association (ELITA): management of hepatitis B virus‐related infection before and after liver transplantation

Duvoux¹,

Belli²,

Fung³

et al. 2021

Aliment Pharmacol Ther

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Summary Background Prophylaxis of HBV recurrence is critical after liver transplantation in HBV patients. Despite new prophylactic schemes, most European LT centres persist on a conservative approach combining hepatitis B immunoglobulin (HBIG) and nucleos(t)ides analogues (NA). Aim This setting prompted the European Liver Intestine Transplantation Association (ELITA) to look for a consensus on the prevention of HBV recurrence. Methods Based on a 4‐round Delphi process, ELITA investigated 16 research questions and established 50 recommendations. Results Prophylaxis should be driven according to 3 simplified risk groups: Low and high virological risk patients, with undetectable and detectable HBV DNA pre‐LT, respectively, and special populations (HDV, HCC, poorly adherent patients). In low‐risk patients, short‐term (4 weeks) combination of third‐generation NA+ HBIG, or third generation NA monotherapy can be considered as prophylactic options. In high‐risk patients, HBIG can be discontinued once HBV DNA undetectable. Combined therapy for 1 year is advised. HBV‐HCC patients should be treated according to their virological risk. In HDV/HBV patients, indefinite dual prophylaxis remains the gold standard. Full withdrawal of HBV prophylaxis following or not HBV vaccination should only be attempted in the setting of clinical trials. Organs from HBsAg+ve donors may be considered after assessment of risks, benefits, and patient consent. They should not be used if HDV is present. In poorly adherent patients, dual long‐term prophylaxis is recommended. Budget impact analysis should be taken into account to drive prophylactic regimen. Conclusions These ELITA recommendations should stimulate a more rational and homogeneous approach to HBV prophylaxis across LT programs.

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Shorter hepatitis B immunoglobulin administration is not associated to hepatitis B virus recurrence when receiving combined prophylaxis after liver transplantation

Cited by 15 publications

References 29 publications

The role of hepatitis B core‐related antigen in predicting hepatitis B virus recurrence after liver transplantation

The role of hepatitis B core‐related antigen in predicting hepatitis B virus recurrence after liver transplantation

S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) zur Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion – (AWMF-Register-Nr. 021-11)

2020 position statement and recommendations of the European Liver and Intestine Transplantation Association (ELITA): management of hepatitis B virus‐related infection before and after liver transplantation

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