Safety of complete and sustained prophylaxis withdrawal in patients liver-transplanted for HBV-related cirrhosis at low risk of HBV recurrence

High Genetic Barrier Nucleos(t)ide Analogue(s) for Prophylaxis From Hepatitis B Virus Recurrence After Liver Transplantation: A Systematic Review

“…However, the long-term outcome of HBsAgpositive, HBV DNA negative transplant patients under oral antivirals but also under immunosuppressive agents needs further study. Interestingly, in a recent study (69), (20%) of 25 HBV transplant patients who discontinued any anti-HBV prophylaxis became HBsAg-positive, but none of them experienced any clinically relevant event and three eventually cleared HBsAg and achieved seroconversion to anti-HBs without any therapeutic intervention. Thus, in case of HBIG-free post-LT HBV prophylaxis, the definition of HBV recurrence might be reconsidered, as HBsAg seropositivity alone in patients under hgbNA(s) may not have any clinical impact on the long-term graft and patient survival.…”

Prevention of Hepatitis B Virus Reinfection in Liver Transplant Recipients

“…Whatever the prophylaxis used, measurable low levels of HBV DNA have been reported after LT in serum, peripheral blood mononuclear cells, and in liver - both total and/or cccDNA - in a significant proportion of patients without detectable HBsAg and without evidence of chronic hepatitis on liver graft [9,10]. These findings suggest that occult HBV reinfection occurs in some HBV recipients and implies a risk for overt HBV recurrence if prophylaxis is stopped.…”

“…The use of nucleos(t)ide agents before LT and the combination of prophylaxis with antiviral and HBIG after LT prevents HBV recurrence in 90-100% of patients, with survival rates at 5 years over 80% [8]. There is a consensus regarding the use of lifelong HBV prophylactic therapy supported by the detection of low levels of HBV DNA in serum, liver and peripheral blood mononuclear cells, or the presence of total and covalently closed circular HBV DNA in liver tissue transiently after LT in the absence of a positive HBsAg [9,10]. However, this long-term prophylaxis using IV HBIG is expensive and inconvenient for patients.…”

Safety of Complete and Sustained Prophylaxis Withdrawal in Patients Liver-transplanted for Hepatitis B Virus-related Cirrhosis at Low Risk of Hepatitis B Virus Recurrence

“…These patients are ideally suited for prophylactic strategies that minimize HBIg use. This low-risk group-HBe-antigen-negative and HBV-DNA undetectablewas the target group for withdrawal of prophylaxis in the study by Lenci et al 3 Lenci et al 3 evaluated a subgroup of transplant recipients who are not at risk for HBV recurrence and in whom prophylactic therapy can be discontinued. All 30 patients included in the study were at a low risk for recurrence (HBsAg-positive, HBe-antigen-negative, and HBV-DNAnegative at transplant) and treated with combination HBIg and lamivudine (± adefovir) for at least 3 years.…”