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Entecavir monotherapy is effective in suppressing hepatitis B virus after liver transplantation.

AbstractBACKGROUND & AIMS:
We investigated the efficacy of entecavir, a cyclopentyl guanosine nucleoside analogue, as monoprophylaxis in patients with chronic hepatitis B who received a liver transplant.
METHODS:
We studied data from 80 consecutive patients who received a liver transplant (47 from living donors and 33 from deceased donors) for hepatitis B-related disease and entecavir monotherapy as prophylaxis. None of the patients received hepatitis B immunoglobulin. Indications for transplant included decompensation from cirrhosis (27.5%), acute-on-chronic hepatitis B (47.5%), and hepatocellular carcinoma (25%). The median follow-up time was 26 months (range, 5-40 months). Before transplant, 33 patients were not on antiviral therapy and 47 were on oral therapy (18 had received less than 3 months of treatment).
RESULTS:
At the time of transplant, the median log HBV DNA level was 3.5 copies/mL (range, 1.54-8.81); 21 patients (26%) had undetectable levels of HBV DNA. The cumulative rate of hepatitis B surface antigen (HBsAg) loss was 86% and 91% after 1 and 2 years, respectively. Ten patients had reappearance of HBsAg. Eighteen patients (22.5%) were HBsAg positive at the time of their last examination; 17 of these had undetectable levels of HBV DNA, and the remaining patient had a low level of HBV DNA (217 copies/mL). There was no evidence of mutations at sites that confer resistance to entecavir among patients who were HBsAg positive.
CONCLUSIONS:
Although only 26% of patients had complete viral suppression at the time of transplant, 91% lost HBsAg, with 98.8% achieving undetectable levels of HBV DNA. A hepatitis B immunoglobulin-free regimen of entecavir monotherapy is effective after liver transplantation for chronic hepatitis B.
AuthorsJames Fung, Cindy Cheung, See-Ching Chan, Man-Fung Yuen, Kenneth S H Chok, William Sharr, Wing-Chiu Dai, Albert C Y Chan, Tan-To Cheung, Simon Tsang, Banny Lam, Ching-Lung Lai, Chung-Mau Lo
JournalGastroenterology (Gastroenterology) Vol. 141 Issue 4 Pg. 1212-9 (Oct 2011) ISSN: 1528-0012 [Electronic] United States
PMID21762659 (Publication Type: Journal Article)
CopyrightCopyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Antiviral Agents
  • Biomarkers
  • DNA, Viral
  • Hepatitis B Surface Antigens
  • Immunosuppressive Agents
  • entecavir
  • Guanine
Topics
  • Adult
  • Aged
  • Antiviral Agents (adverse effects, therapeutic use)
  • Biomarkers (blood)
  • Carcinoma, Hepatocellular (surgery, virology)
  • Chi-Square Distribution
  • DNA, Viral (blood)
  • Female
  • Guanine (adverse effects, analogs & derivatives, therapeutic use)
  • Hepatitis B Surface Antigens (blood)
  • Hepatitis B virus (genetics, immunology)
  • Hepatitis B, Chronic (complications, diagnosis, drug therapy, surgery)
  • Hong Kong
  • Humans
  • Immunosuppressive Agents (therapeutic use)
  • Kaplan-Meier Estimate
  • Liver Cirrhosis (surgery, virology)
  • Liver Neoplasms (surgery, virology)
  • Liver Transplantation
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Postoperative Care
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Viral Load
  • Young Adult

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