The role of HBIG in real life for patients undergoing liver transplantation due to HDV‐related cirrhosis

Abstract

Recommended post‐liver transplant (LT) prophylaxis in patients with hepatitis delta includes a nucleos(t)ide analogue (NA) and anti‐hepatitis B immunoglobulin (HBIG) indefinitely. We analysed the use of HBIG in real‐life clinical practice and its impact on HBV/HDV recurrence in 174 HDV‐related LT patients from 10 Spanish liver transplant centres (1988–2018). Median post‐LT follow‐up was 7.8 (2.3–15.1) years and patient survival at 5 years was 90%. Most patients (97%) received HBIG in the immediate post‐LT, but only 42% were on HBIG at the last control. Among those discontinuing HBIG, the median time on treatment was 18 (7–52) months. Post‐LT HBsAg+ was detected in 16 (9%) patients and HBV‐DNA in 12 (7%). Despite HBsAg positivity, HDV recurrence was reported only in three patients (1.7%), all of whom were not receiving NA and had discontinued HBIG. Our data suggest that a finite HBIG prophylaxis in HDV‐LT is feasible, especially if high‐barrier NAs are used.