Entecavir and other nucleos(t)ide analogs prophylaxis in hepatitis B virus-related liver transplantation: long-term efficacy and safety

Darweesh, Samar K; Gad, Amal; Akroof, Kafya; ElLatif, Zainab A

doi:10.1097/meg.0000000000001377

Cited by 13 publications

(12 citation statements)

References 18 publications

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“…Another 2 studies demonstrated a trend toward improved eGFR/CKD stage under sequential TAF treatment following TDF or HBIG+NAs 48,49 . The renal function remained at a stable level in other trials 35,36,40,41,52 .…”

Section: Renal Functionmentioning

confidence: 81%

The Strategy and Efficacy of Prophylaxis Against Hepatitis B Virus Recurrence After Liver Transplantation in the Era of High Potent Nucleos(t)ide Analogues: A Meta-Analysis

Li¹,

Hou²,

Yao³

et al. 2020

Preprint

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Background: High potent nucleos(t)ide analogues (HP NAs) with or without hepatitis B immunoglobulin (HBIG) is the standard prophylactic therapy for avoiding the HBV recurrence after liver transplantation (LT). While the clinical impact of HP NAs-based prophylaxis has not been well documented, the optimal treatment strategy is currently debated. This meta-analysis aims to evaluate clinical outcome of LT recipients under HP NAs-based regimens and investigate different prophylaxis schemes. Methods: We followed PRISMA statement to conduct this study. Two reviewers independently searched relevant literature via PubMed, EMBAES, MEDLINE, Web of Science, and Google Scholar. Studies were included if they observed HBV recurrence under HP NAs-based regimens in patients who received HBV-related LT. Primary and secondary outcome were HBV recurrence, HCC recurrence, all-cause and HBV-recurrence related mortality. Incidence with 95% confidence intervals was aggregated and assess by fixed effect model/random effect model. Subgroup analysis was applied to examine the impact of different treatment strategies. Results: 26 studies (n=2374) were included, with a pooled HBV recurrence rate of 0.92% (95% CI 0.47%-1.48%). Studies with and without HBV viremia or HDV superinfected patients demonstrated comparable HBV recurrence (p=0.25, p=0.69). Recurrence rate under indefinite combination of HP NAs and HBIG was lower than that under HP NAs monotherapy (p=0.0003), and similar to that under NAs plus finite course of HBIG (p=0.53). Pooled HCC recurrence rate was 5.34% (95% CI 0.78%-12.48%). HBV-recurrence related mortality and all-cause mortality were 0.17% (95% CI 0.00%-1.51%) and 7.29% (95% CI 4.42%–10.71%) respectively. Conclusion: Our study suggests HP NAs-based regimens provide satisfactory HBV antiviral prophylaxis and improved long-term outcome for LT recipients. Finite combination of HP NAs and HBIG is an alternative to lifelong dual therapy.

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Section: Renal Functionmentioning

confidence: 81%

The Strategy and Efficacy of Prophylaxis Against Hepatitis B Virus Recurrence After Liver Transplantation in the Era of High Potent Nucleos(t)ide Analogues: A Meta-Analysis

Li¹,

Hou²,

Yao³

et al. 2020

Preprint

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“…With the severity of organ shortage and the improved perioperative management measures, this type of graft has then been used in HBV‐unrelated patients and also showed low incidence of de novo HBV infection under nucleoside analogue (NA) prophylaxis. ( 7,13 ) The pediatric patients with end‐stage liver disease are mostly free of HBV infection, so the use of HBcAb‐positive liver graft in pediatric patients would add potential risk of de novo HBV infection. However, approximately 50% of the population in China is positive for HBcAb, ( 11,14 ) and more than one‐third of the donors in our current study were HBcAb positive.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Strategy Against De Novo Hepatitis B Virus Infection for Pediatric Recipients Who Receive Hepatitis B Core Antibody–Positive Liver Grafts

et al. 2020

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The goal of this study was to evaluate the efficacy of a perioperative prophylactic strategy against de novo hepatitis B virus (HBV) infection in pediatric liver transplantation (LT) recipients with hepatitis B core antibody (HBcAb)-positive grafts. A total of 482 pediatric recipients transplanted between 2013 and 2017 were enrolled, and 170 recipients received HBcAbpositive liver grafts. The overall graft and recipient survival rates in HBcAb-positive and HBcAb-negative graft recipients were 91.8% versus 91.3% and 95.3% versus 94.2% at the end of follow-up. Preoperative hepatitis B surface antibody (HBsAb) titer ≥ 1000 IU/L and postoperative HBsAb titer ≥200 IU/L were our prophylactic targets for recipients receiving HBcAbpositive grafts. While 11 recipients developed de novo HBV infection, 10 received HBcAb-positive grafts. Both the preoperative and postoperative HBsAb targets were achieved in 78 recipients, the infection rate of de novo HBV was 1.3%; 24 recipients met the preoperative target, the infection rate was 4.2%; 52 recipients met the postoperative target, the infection rate was 1.9%; and 16 recipients met neither the preoperative nor postoperative HBsAb target, 43.8% of the recipients were infected with de novo HBV, which was significantly higher than the recipients who met both or either of the preoperative and postoperative targets. Split-liver grafts positive for HBcAb showed higher risk of de novo HBV infection. Postoperative application of lamivudine to recipients whose preoperative HBsAb titer < 1000 IU/L did not show preventive effect. Out of 11 infected recipients, 3 showed seroconversion under entecavir treatment. In conclusion, the graft and recipient survival rates were similar in pediatric LT recipients receiving HBcAb-positive or HBcAb-negative grafts. Our prophylactic strategy was effective for preventing de novo HBV infection in HBcAb-positive liver graft recipients.

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“…41 In a recent retrospective study including 44 patients (86% with positivity for HBV DNA at the time of LT), none of the 34 patients receiving the combination of ETV with HBIg tested positive for HBsAg in the 8 year follow-up period. 42 However, four out of the fourteen patients on ETV plus another NA (TDF/ LAM) with HBIg developed recurrence with positive HBsAg, which eventually converted to HBsAb towards the end of the 8 year follow-up period. There was no evidence of clinically significant hepatitis or presence of HBV DNA in these patients.…”

Section: Nas With or Without Hbigmentioning

confidence: 93%

Prevention of HBV Recurrence after Liver Transplant: A Review

Nasir

2020

Journal of Clinical and Translational Hepatology

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Globally, hepatitis B virus (HBV) infection is recognized as a major risk factor for the development of hepatocellular carcinoma, and HBV-induced liver failure is one of the leading indications for liver transplantation. Until about two decades ago, liver transplantation in patients with chronic HBV infection was a relative contraindication, due to high risk of viral replication with the use of immunosuppressants which could result in graft infection. In the 1990s, hepatitis B immunoglobulin (HBIg) use significantly reduced the risk of graft infection, improving outcomes of liver transplant in patients with chronic HBV infection. However, very high costs, especially with the need for long-term use, became a major concern. With the advent of nucleos(t)ide analogs (NAs), there was less need for high-dose, long-term HBIg use to prevent HBV recurrence. Lamivudine was initially used but resistance soon became a major issue. This was followed by more potent NAs, such as entecavir and tenofovir, emerging as the more preferred agents. Additionally, the use of these antiviral agents (HBIg and/or NAs) have made it possible to use the grafts from donors with positivity for hepatitis B core antibody, allowing for expansion of the donor pool. Nevertheless, there is no consensus on management protocols, which vary significantly amongst centers. In this review, we appraise studies on management strategies used and the role of active vaccination in the prevention of HBV recurrence in post-liver transplant patients.

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Entecavir and other nucleos(t)ide analogs prophylaxis in hepatitis B virus-related liver transplantation: long-term efficacy and safety

Cited by 13 publications

References 18 publications

The Strategy and Efficacy of Prophylaxis Against Hepatitis B Virus Recurrence After Liver Transplantation in the Era of High Potent Nucleos(t)ide Analogues: A Meta-Analysis

The Strategy and Efficacy of Prophylaxis Against Hepatitis B Virus Recurrence After Liver Transplantation in the Era of High Potent Nucleos(t)ide Analogues: A Meta-Analysis

Prophylactic Strategy Against De Novo Hepatitis B Virus Infection for Pediatric Recipients Who Receive Hepatitis B Core Antibody–Positive Liver Grafts

Prevention of HBV Recurrence after Liver Transplant: A Review

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