Protocol liver biopsies in long-term management of patients transplanted for hepatitis B-related liver disease

Abstract

Though protocol biopsies may enable the detection of graft dysfunction at an early stage, the risk of progression and the clinical significance of these findings remains to be determined.

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“…In some studies, intramuscular HBIg during the posttransplant period is equally effective to IV HBIg; it has resulted in reduction of anti-HB titers to the same levels as IV HBIg, to a 0% to 24% HBV reinfection rate after liver transplant. [16][17][18][19] The great advantage of intramuscular administration of HBIg, compared to the IV route, is a substantial reduction in HBIg dose needed to achieve adequate titers, as well as cost reduction. However, intramuscular administration involves a painful injection.…”

“…At 91 months of followup, 15% of patients for whom HBIg was discontinued showed signs of HBV reinfection, a rate similar to the 11% of patients receiving HBIg with lamivudine. 24 In another randomized study, 25,18 patients received HBIg with lamivudine, but HBIg was replaced with adefovir at the 1 year posttransplant. These patients were compared to 18 patients who received HBIg in combination with lamivudine indefinitely.…”

Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

“…Some reports have shown that the efficacy of the lowdose HBIg and LAM combination therapy is similar to that of the high-dose protocol (Table 1) (41,42,47). In several studies, administration of HBIg at low doses (300-800 IU) through the IM rather than the IV route has been shown to reduce the cost of prophylactic therapy, making the low-dose protocol as effective as the high-dose protocol (7, 8, 14, 19, 38, 39, 41-51, 59, 63) (Table 1).…”

“…The administration of low dose intramuscular (IM) HBIg has been discussed as an accepted alternative route to IV administration in several studies worldwide (Table 1) (2,3,14,(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52). However, given the limited volumes that can be given per IM injection, only patients with low HBIg requirements are suited for IM HBIg administration (9,53).…”

Recurrent diseases following liver transplantation

“…The overall long-term outcome, graft and patient survival rate was poor in this setting. In a recent singlecenter study, it has been shown that the patients followed over the 20-year period have an excellent 5-year survival rate (82%) and low 5-year risk of HBV recurrence (5%) when the combination prophylaxis with HBIg and an antiviral agent is administered, regardless of pretransplantation HBV DNA levels [56]. The recurrence rate is currently 16-18%.…”