Hepatitis B prophylaxis post‐liver transplant without maintenance hepatitis B immunoglobulin therapy
- 22 February 2006
- journal article
- Published by Wiley in Clinical Transplantation
- Vol. 20 (2), 206-210
- https://doi.org/10.1111/j.1399-0012.2005.00467.x
Abstract
Background: We examined outcomes in recipients who underwent a liver transplant for HBV-induced liver disease and received a protocol for prophylaxis that did not use HBIG maintenance. Results: Between October 2002 and July 2005, a total of 14 liver transplant recipients were identified that met the study criteria. Mean recipient age was 47.6 yr; mean donor age was 37.2 yr. Category of transplant was as follows: cadaveric liver (n=10, 71%), cadaveric split-liver (n=2, 14%), and cadaveric liver–kidney (n=2, 14%). Liver disease was diagnosed at a mean of 7.3 yr before transplant; three (21%) had a coexisting hepatocellular cancer at the time of transplant. Pre-transplant, all 14 (100%) recipients were hepatitis B surface antigen (HBsAg) positive, and 11 (79%) were HBV DNA positive (mean viral load of 251.2 pg/mL). Three (21%) were E antigen positive, and one (7%) was D antigen positive. Pre-transplant, seven patients (50%) were on anti-viral therapy and there was documented diminution in viral loads after initiating anti-viral therapy in 3 cases. Three (21%) were hepatitis C virus (HCV) antigen positive and all had low-RNA titers. With mean follow-up of 14.1 months, all 14 patients are alive with a functioning graft. Mean ALT, AST and total bilirubin values are currently at 43.2, 32.2, and 0.84, respectively. One recipient remains HBsAg surface antigen positive post-transplant but has normal lab values. The remaining recipients have no evidence of HBV recurrence by serology and protocol biopsies. The regimen has been well tolerated without the need for drug reduction or discontinuation because of side-effects. Conclusion: Longer follow-up is needed, but this regimen may represent an alternative to chronic HBIG maintenance therapy.Keywords
This publication has 20 references indexed in Scilit:
- Treatments for Hepatitis BClinical Infectious Diseases, 2004
- Evolving strategies to prevent HBV recurrenceLiver Transplantation, 2004
- Week 48 resistance surveillance in two phase 3 clinical studies of adefovir dipivoxil for chronic hepatitis BHepatology, 2003
- Hepatitis B immune globulin to prevent hepatitis B virus graft reinfection following liver transplantation: A concise reviewHepatology, 2000
- Combination Low-Dose Hepatitis B Immune Globulin and Lamivudine Therapy Provides Effective Prophylaxis Against Posttransplantation Hepatitis BLiver Transplantation, 2000
- Intramuscular hepatitis B immune globulin combined with lamivudine for prophylaxis against hepatitis B recurrence after liver transplantationLiver Transplantation and Surgery, 1999
- Incidence and clinical consequences of surface and polymerase gene mutations in liver transplant recipients on hepatitis B immunoglobulinHepatology, 1998
- Prophylaxis in liver transplant recipients using a fixed dosing schedule of hepatitis B immunoglobulinHepatology, 1996
- Prophylaxis in liver transplant recipients using a fixed dosing schedule of hepatitis B immunoglobulinHepatology, 1996
- Hepatitis B virus reinfection after orthotopic liver transplantation: Serological and clinical implicationsJournal of Hepatology, 1992