Cost Effectiveness of Limited Hepatitis B Immunoglobulin Course in The Era of Potent Nucleos(t)ide Analogues for Post Liver Transplant Hepatitis B Virus Prophylaxis.

Fayek, Sameh; Singer, Gary; Zielsdorf, Shannon; Fleetwood, Vidya A.; Eswaran, Sheila; Cohen, Eric; Alvey, Nicole; Shah, Nikunj; Hertl, Martin; Chan, Edie Y.

doi:10.1097/00007890-201407151-02399

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“…While the combination of NAs and passive immunization with hepatitis B immunoglobulins (HBIG) revolutionized the effective control of reinfection and replication, recent studies indicated NA monotherapy after LT for HBV-associated ESLD might be efficient with comparable outcomes in certain subgroups [6]. As HBIG therapy was initially recommended in a life-long manner, the evaluation of the reduction and eventual discontinuation entails significant costs and lack of patient's adherence, as the substance needs to be administered intravenously or subcutaneously [7][8][9][10].…”

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confidence: 99%

Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection

Saidy

Sud

Eurich

et al. 2021

Viruses

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Patients after LT due to combined HBV/HDV infection are considered to be high-risk patients for recurrence of hepatitis B and D. To date, life-long prophylaxis with hepatitis B immunoglobulin (HBIG) and replication control with nucleos(t)ide analogs (NA) remains standard. We examined the course of 36 patients that underwent liver transplantation from 1989 to 2020 for combined HBV/HDV-associated end-stage liver disease in this retrospective study. Seventeen patients eventually discontinued HBIG therapy for various reasons. Their graft function, histopathological findings from routine liver biopsies and overall survival were compared with those that received an unaltered NA-based standard regimen combined with HBIG. The median follow-up was 204 and 227 months, respectively. The recurrence of HBV was 25% and did not differ between the groups of standard reinfection prophylaxis NA/HBIG (21.1%) and HBIG discontinuation (29.4%); (p = 0.56). No significant differences were found regarding the clinical course or histopathological aspects of liver tissue damage (inflammation, fibrosis, steatosis) between these two groups. Overall, and adjusted survival did not differ between the groups. Discontinuation of HBIG in stable patients after LT for combined HBV/HDV did not lead to impaired overall survival or higher recurrence rate of HBV/HDV infection in this long-term follow-up. Therefore, the recommendation of the duration of HBG administration must be questioned. The earliest time of discontinuation remains unclear.

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