The efficiency of low-dose Hepatitis B Immunoglobulin plus nucleos(t)ide analogs in preventing post-transplant HBV recurrence

Abstract

Background/aim: In this study, the efficiency of using low-dose HBIG plus antiviral treatment according to individual needs have been evaluated in post-transplant HBV patients. Material and methods: We retrospectively evaluated 179 patients who admitted between 2009-2014. Five thousand IU IV HBIG was given in anhepatic phase, and 400 IU/day IM HBIG was given in the post-transplant period. After HBsAg seroconversion 400 IU IM HBIG every two weeks as prophylaxis was continued. Results: Average follow-up period was 26 (2-65) months. Seventy patients had hepatocellular carcinoma (HCC). The HBV recurrence was 4.5% in the 1st year, and 5.8% in the 3rd year. The HBsAg became negative in 11 (2-63) days, and anti-HBs became positive in 9 (1-31) days. HBsAg positivity occurred in 6 patients during the follow-up period. Five of these patients were those who were transplanted due to HCC. In 5 of the HCC patients whose HBsAg became positive, tumor recurrence was observed after 0.3-9.9 months. HBsAg positivity was more frequently detected in patients with HCC (p=0.009). Conclusion: The HBV recurrence should be evaluated as a predictor of HCC recurrence in patients who were transplanted due to HCC.

State of the art treatment of hepatitis B virus hepatocellular carcinoma and the role of hepatitis B surface antigen post‐liver transplantation and resection

“…Patients with additional HBV DNA positivity at time of LT, patients with HCC, and patients with HBV/HDV coinfection are particularly prone to HBV reinfection without prophylaxis. 64 , 66 , 67 Shorter courses of (lower dose) HBIG, 70 , 71 individualized dosing schedules, 72 , 73 HBIG limiting or sparing regimens, 74 and/or de novo NAs alone 75 , 76 have also been evaluated to reduce the likelihood of HBV reactivation. A recent study has reported HBsAg loss in 100% (n = 41) of patients after 1 year of entecavir monotherapy post‐LT for HBV‐related HCC.…”

“…1 Indeed, a larger study has reported 15% of patients under entecavir monotherapy being HBsAg positive at 1 year post‐LT. 76 HCC as an indication for LT remains a key risk factor for HBV reactivation 73 and is associated strongly with the reappearance of HBsAg after withdrawal of HBIG. 75 HBIGs are not indicated currently for the prevention of HCC recurrence post‐LT.…”

“…77 However, one patient who experienced HCC recurrence in this study was also HBsAg positive after 33 months of HBsAg seroclearance, and robust data from controlled trials on the use of NAs alone are lacking regarding the control of HBsAg production, 78 and current guidelines support the use of combination schedules. 1 Indeed, a larger study has reported 15% of patients under entecavir monotherapy being HBsAg positive at 1 year post-LT. 76 HCC as an indication for LT remains a key risk factor for HBV reactivation 73 and is associated strongly with the reappearance of HBsAg after withdrawal of HBIG. 75 HBIGs are not indicated currently for the prevention of HCC recurrence post-LT.…”

Antiviral prophylaxis against hepatitis B recurrence after liver transplantation: Current concepts

“…Many studies support the efficacy of combination of low‐dose IM HBIG with ETV (or TDF) given indefinitely as an effective prophylaxis against HBV recurrence after LT irrespectively of anti‐HBs levels 53‐56 . Vatansever et al recently reported that low‐dose IM HBIG combined with a NA (LAM, ADV, ETV, TDF or telbivudine) results in 4.5% and 5.8% of HBV recurrence in the first and third year after LT respectively 53 . Likewise, a Chinese registry indicated that low‐dose IM HBIG in combination with a NA (mainly ETV) was an effective prophylactic option against HBV recurrence 54 .…”

“…Several protocols have been recommended and used regarding the dose and duration of HBIG administration in combination with NA 50‐52 . Many studies support the efficacy of combination of low‐dose IM HBIG with ETV (or TDF) given indefinitely as an effective prophylaxis against HBV recurrence after LT irrespectively of anti‐HBs levels 53‐56 . Vatansever et al recently reported that low‐dose IM HBIG combined with a NA (LAM, ADV, ETV, TDF or telbivudine) results in 4.5% and 5.8% of HBV recurrence in the first and third year after LT respectively 53 .…”