The long‐term efficacy of nucleos(t)ide analog plus a year of low‐dose HBIG to prevent HBV recurrence post‐liver transplantation

Abstract

Hepatitis B immunoglobulin (HBIG), given in combination with nucleos(t)ide therapy, has reduced the rate of recurrent hepatitis B virus (HBV) following liver transplantation (LT), although the most effective protocol is unknown. We have retrospectively evaluated the use of long-term nucleos(t)ide analog in combination with one yr of low-dose HBIG. One hundred and fifty-two adults with HBV-related liver disease underwent LT in our center from January 1999 to August 2009; of these, 132 patients who received one yr of HBIG combined with long-term nucleos(t)ide analogs (largely on lamivudine [LAM] alone, n = 97) afterward were included for the purposes of this study. Median follow-up post-transplantation was 1752 d. Patient survival was 93.9%, 86.9% and 84.1% at 1, 5, and 10 yr, respectively; none of the 17 deceased patients had recurrent HBV. HBV recurrence was observed in nine patients (all received LAM+HBIG), yielding recurrence rates of 2.3%, 5.1%, and 8.6% at 1, 3, and 5/10 yr, respectively. All recurrences were successfully managed, usually with additional antiviral treatment. In conclusion, this study, with its long-term follow-up, demonstrates that short course of low-dose HBIG (without anti-HBs monitoring) combined with the use of long-term nucleos(t)ide analog is effective and less cumbersome than many protocols in current use.

The progress and prospects of routine prophylactic antiviral treatment in hepatitis B-related hepatocellular carcinoma

“…Compared to NA monotherapy, NA treatment in conjunction with HBIG has even better outcomes for HBsAg clearance rates in liver transplantation patients [72,73]. A short course of low-dose HBIG combined with long-term NA antiviral treatment has been demonstrated to be an effective therapy to prevent HBV recurrence in liver transplantation patients [74].…”

Management of Chronic Hepatitis B in Patients from Special Populations

“…Resistance to lamivudine, because of the development of the tyrosine methionine aspartate aspartate (YMDD) mutations, is treated with adefovir, high-dose entecavir or, more recently, tenofovir. Studies have shown that just 1 yr of HBIG when combined with lamivudine, is effective and cost-saving, with only 8.9% of patients developing resistance at 5-10 yr of follow-up (Tanaka et al 2012). All recurrences were treated successfully with additional antiviral therapy.…”

Efficacy and effectiveness of anti-HBV therapy with early withdrawal of HBIG prophylaxis to prevent HBV recurrence following liver transplantation

“…In total, 17 patients died during follow-up with six deaths due to HCC recurrence; however, none of the deceased patients had HBV recurrence. Patient survival rate was noted to be 93.9, 86.9 and 84.1% at years 1, 5 and 10, respectively [15]. Newer nucleos(t)ide analogs such as ETV and TDF have a much higher barrier to resistance rate compared to LAM monotherapy and are, therefore, the preferred therapy, especially in the post-LT setting [9,10].…”