Low‐dose anti‐hepatitis B immunoglobulin regimen as prophylaxis for hepatitis B recurrence after liver transplantation

Lee, Wei‐Chen; Chou, Hong‐Shiue; Wu, Tsung-Han; Cheng, Chih‐Hsien; Lee, Chen-Fang; Wang, Yuchao; Wu, Ting-Jung; Chan, Kun‐Ming

doi:10.1111/tid.13190

Cited by 13 publications

(10 citation statements)

References 38 publications

(42 reference statements)

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“…The recurrent HCC remained an alarming signal. Its association with HBV reactivation was revealed by Idilman R, Lee WC et al who con rmed 21.4% to 100% cases of recurrence detected with concomitant HCC recurrence 32,39,44,50 . For HP NAs, the recurrent HCC was supposed to present following challenges: HBV within tumor cells might be relatively inaccessible to drug because of the change in liver structure and blood supply.…”

Section: Discussionmentioning

confidence: 91%

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: Discussionmentioning

confidence: 91%

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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“…3 The cccDNA is a template for transcription of viral RNA. 4 The transcribed pregenomic RNA (pgRNA) undergoes reverse transcription, 5 forming rcDNA. At the endoplasmic reticulum, virions assemble (not shown in diagram) 6 and the mature virions are excreted from the host cell via budding.…”

Section: Hbig Monotherapymentioning

confidence: 99%

“…Combination of HBIg and NAs can also be used. However, there are no standardized protocols for the prevention of HBV recurrence after LT. 5 In addition, the high cost of long-term HBIg use and resistance to certain NAs can limit their use, requiring alternate management strategies. Additionally, factors, such as presence of hepatitis B core antibody (HBcAb), 6 HBsAg or HBV DNA at the time of LT introduce varying degrees of risk of recurrence post-LT.…”

Section: Introductionmentioning

confidence: 99%

“…Over the past two decades, with the use of hepatitis B immunoglobulin (HBIg) and oral antivirals, a significant reduction in post-transplant recurrence of HBV infection has been noted, allowing for successful LT in patients with chronic hepatitis B. 5 The goal of antiviral therapy is the suppression of HBV DNA and preferably achievement of sustained virologic response (SVR). HBIg can be used to neutralize viral particles by binding to HBsAg, while nucleos(t)ide analogs (NAs) can be used to inhibit viral reverse transcriptase with consequent inhibition of HBV DNA replication.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Briefly, 10000 IU of HBIg was given intravenously at anhepatic phase followed by 2000 IU of HBIg intravenously every day in the first week after transplantation. 800 IU of HBIg was boosted for the patients with quick decline of HBIg every month for 6 courses [12]. Antihepatitis B viral nucleotide/nucleoside analog was given throughout life.…”

Section: Definition Of Hepatitis Bmentioning

confidence: 99%

Significance of Hepatitis B Recurrence in Liver Transplantation Recipients

Chou

Cheng

Hung

et al. 2020

BioMed Research International

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Background. A combination of antihepatitis B immunoglobulin and antiviral agents is the most common regimen for prophylaxis of hepatitis B recurrence after liver transplantation. However, hepatitis B recurrence still happens. The significance of hepatitis B recurrence is less mentioned. Materials. Forty-eight of the 313 hepatitis B liver transplant recipients having hepatitis B recurrence were included in this study. The patients were divided into group A, the patients transplanted for hepatitis B-related liver failure, and group B, the patients transplanted for hepatitis B-related cirrhosis and HCC. The clinical manifestations after hepatitis B recurrence were recorded. Results. Among the 48 patients with hepatitis B recurrence, 23 patients were in group A and 25 patients in group B. The age was 51.6±9.4 years in group A and 52.8±6.4 in group B (p=0.869). The MELD score prior to transplantation was 23.1±9.9 in group A patients and 12.9±5.6 in group B patients (p<0.001). The median (interquartile) interval from transplantation to hepatitis B recurrence was 10 (2-19) months for group A patients and 13 (8.5-35) months for group B patients (p=0.051). After hepatitis B recurrence, the liver function was almost normal in both groups. In group B patients, 10 patients had HCC recurrence with 7 of 10 patients having hepatitis B recurrence earlier than HCC recurrence. The interval between hepatitis B and HCC recurrence was 1 to 15 months. The 1-, 3-, and 5-year survival rates were 82.6%, 73.9%, and 69.0%, respectively, for group A patients and 96%, 76%, and 68%, respectively, for group B patients (p=0.713). Conclusion. The patients have uneventful liver function under antiviral agent while hepatitis B recurred. For the patients having HCC prior to transplantation, close monitoring of HCC recurrence is necessary if hepatitis B recurs.

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Low‐dose anti‐hepatitis B immunoglobulin regimen as prophylaxis for hepatitis B recurrence after liver transplantation

Cited by 13 publications

References 38 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

Prevention of HBV Recurrence after Liver Transplant: A Review

Significance of Hepatitis B Recurrence in Liver Transplantation Recipients

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