The role of entecavir in preventing hepatitis B recurrence after liver transplantation

Abstract

OBJECTIVE:Although hepatitis B recurrence after liver transplantation has been reduced to 0%-10% since the application of the combination therapy of hepatitis B immunoglobulin (HBIG) and lamivudine, the viral mutation resistance of lamivudine is still an obstacle to the outcome of liver transplantation. Here we evaluate the role of entecavir in preventing hepatitis B recurrence after liver transplantation. METHODS:Patients who received a liver transplantation for hepatitis B virus (HBV)-related end-stage liver disease in our center from March 2006 to December 2008 were enrolled in this study. All patients received entecavir (0.5 mg orally, daily) or lamivudine (100 mg orally, daily) together with a long-term low dosage of HBIG to prevent hepatitis B recurrence after transplantation. Serum viral markers (HBsAg, antiHBs, HBeAg, anti-HBc and anti-HBe) and HBV-DNA level were determined. RESULTS:Thirty patients receiving entecavir and 90 patients receiving lamivudine were matched with the same age and sex in both groups. No reinfection of hepatitis B was detected in the entecavir group. The hepatitis B surface antigen of patients in the entecavir group became negative within one week and no patient had any adverse effect relating to entecavir. There was no difference in the cumulative survival rate between the entecavir group and the lamivudine group (P > 0.05). CONCLUSION:This study shows that entecavir combined with low dosages of HBIG is effective and safe in preventing hepatitis B recurrence after liver transplantation, but its long-term effect is still under investigation and a large-sample study will be carried out in the future.

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“…28 This can be largely attributed to the greatly reduced recurrence rate of hepatitis after liver transplant in patients with HBV infection after the introduction of prophylactic therapy in the form of either lamivudine and hepatitis B immunoglobulin or entecavir and hepatitis B immunoglobulin. 9,21,[32][33][34][35] We found significantly low patient and graft survival in patients with both HBV and HCV in our study; this finding is similar to the results of Waki and associates, 36 who analyzed data from the United Network for Organ Sharing for liver graft survival in patients with different types of viral hepatitis and found that recipients with HBV had the highest graft survival compared with patients with HCV infection or patients with combined HBV and HCV. In our study, we only had 5 patients with combined HBV and HCV; all of these patients had fulminant hepatic failure and 4 had concomitant HCC, which resulted in worse prognosis.…”

Simple nucleos(t)ides as HBV prophylaxis regime of post-liver transplantation: Six-year followed up

“…Therefore, NAs of more potency and less resistance (telbivudine, en tecavir, and tenofovir) are to be preferred. Although there are few studies of these newer antivirals being used as HBV prophylaxis updates [21,22] , in accordance with wide use in patients with chronic hepatitis B, they should still replace LMV within prophylaxis regimens in LT patients. With the properties they have, it could be expected that more successful HBIgfree regimens could be established, but most up to date studies have been limited by short term followups.…”

Controversies Regarding the Hepatitis B Immune Globulin Prophylaxis (HBIG) for Liver Transplantation Recipients

“…Pan/2011 [58] Park/2002 [134] Prakaso/2006 [135] Roque-Afonso/2002 [136] Rosenau/2001 [137] Seehofer/2002 [138] Sousa/2003 [139] Steinmuller/2002 [53] Singham/2010 [ Xi/2009 [100] Xie/2010 [136] Yilmaz/2008 [48] Yi/2007 [141] Yan/2006 [142] Yang/2007 [143] Yoshida/2007 [46] Yu/2001 [144] Yuefeng/2011 [145] Zheng/2006 [30] Zhu/2003 [146] Sample No Table 2 Summary of studies for prevention of HBV recurrence after liver transplantation using new NA in combination with HBIg.…”

“…ComposVarela/2011 [38] Cai/2012 [147] Di Costanzo/2013 [22] Gao [103] Hwang/2011 [97] Hwang/2008 [98] Hu/2012 [148] Ishigami/2011 [149] Kim/2013 [104] Jiménez-Pérez/2010 [93] McGonigal/2013 [101] Perrella/2012 [56] Perrakis/2013 [100] Perrillo/2013 [150] Roche/2010 [28] Tanaka/2012 [102] Teperman/2010 [57] Ueda/2013 [151] Varghese/2014 [105] Xie/2010 [95] Xi/2009 [100] Yasunaka/2011 [46] antiviral NAs and further studies needed to test their effectiveness as part of combination therapy with HBIG and/or montherapy strategies [78][79][80] .…”

“…Although the sample size of the patients-studied was low in compare with Lam-receiving patients, the reported recurrence after prophylaxis with ADV was 0% [44,87,99] . Among new NAs, entecavir, telbivudine, tenofovir and emtricitabine have been used with 0% recurrence rate (Table 2) [22, 46,56,93,95,[100][101][102][103][104][105] .…”