Impact of Virologic Breakthrough and HBIG Regimen on Hepatitis B Recurrence After Liver Transplantation

• Published in: American journal of transplantation Vol. 10; no. 8; pp. 1823 - 1833
• Main Authors: Degertekin, B., Han, Steven‐Huy B., Keeffe, E. B., Schiff, E. R., Luketic, V. A., Brown, Jr, R. S., Emre, S., Soldevila‐Pico, C., Reddy, K. R., Ishitani, M. B., Tran, T. T., Pruett, T. L., Lok, A. S. F.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-08-2010; Wiley
• Subjects: Adefovir; Adolescent; Adult; antiviral resistance; Biological and medical sciences; Data processing; DNA; DNA, Viral - analysis; Female; HBV DNA; Hepatitis B - drug therapy; Hepatitis B - prevention & control; hepatitis B e antigen; Hepatitis B e Antigens - immunology; Hepatitis B virus; Human viral diseases; Humans; Immunoglobulins; Immunoglobulins - administration & dosage; Immunoglobulins - therapeutic use; Infectious diseases; Intravenous administration; lamivudine; Liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - immunology; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Multivariate analysis; Prophylaxis; Secondary Prevention; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Viral diseases; Viral hepatitis; Relapse; antiviral resistance; Digestive system; Liver; Hepatic disease; Homotransplantation; hepatitis B e antigen; Infection; Viral hepatitis B; Adefovir; Treatment; Surgery; Viral disease; HBV DNA; Graft; Digestive diseases; Therapeutic protocol; Liver transplantation; lamivudine
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2010.03046.x

The availability of hepatitis B immune globulin (HBIG) and several oral antiviral therapies has reduced but not eliminated hepatitis B virus (HBV) recurrence. We aimed to determine the rate of HBV recurrence after orthotopic liver transplantation (OLT) in relation to virologic breakthrough pre‐OLT and HBIG regimens post‐OLT. Data from the NIH HBV‐OLT database were analyzed. A total of 183 patients transplanted between 2001 and 2007 followed for a median of 42 months (range 1–81) post‐OLT were studied. At transplant, 29% were hepatitis B e antigen (HBeAg) (+), 38.5% had HBV DNA > 5 log10 copies/mL, 74% were receiving antiviral therapy. Twenty‐five patients experienced virologic breakthrough before OLT. Post‐OLT, 26%, 22%, 40% and 12% of patients received intravenous (IV) high‐dose, IV low‐dose, intramuscular low‐dose and a finite duration of HBIG, respectively as maintenance prophylaxis. All but two patients also received antiviral therapy. Cumulative rates of HBV recurrence at 1 and 5 years were 3% and 9%, respectively. Multivariate analysis showed that listing HBeAg status and HBV DNA level at OLT were the only factors associated with HBV recurrence. In conclusion, low rates of HBV recurrence can be accomplished with all the HBIG regimens used when combined with antiviral therapy including patients with breakthrough pre‐OLT as long as rescue therapy is administered pre‐ and post‐OLT.
In 183 liver transplants for hepatitis B, low dose or finite duration of HBIG when combined with antiviral therapy resulted in low rates of HBV recurrence after liver transplantation, including patients with breakthrough pretransplant, as long as rescue therapy is administered pre‐ and post‐transplant.
See Editorial by Gane on page 1721.