Low-dose short-term hepatitis B immunoglobulin with high genetic barrier antivirals: the ideal post-transplant hepatitis B virus prophylaxis?

Abstract

BACKGROUND:

Low-dose hepatitis B immunoglobulin (HBIG) and nucleos(t)ides analogs (lamivudine/adefovir) used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT) are associated with some risk of HBV recurrence and antiviral resistance.

METHODS:

The study cohort included 176 patients (at least >12 months follow-up) with HBV cirrhosis/hepatocellular carcinoma who received secondary prophylaxis with indefinite entecavir/tenofovir after living-donor LT (LDLT). All patients received 10,000 IU intravenous HBIG in anhepatic phase followed by 600-1000 IU intramuscularly daily for 7 days, weekly for 3 weeks, and then monthly, to keep antiHBs levels >100 mIU/mL for 1 year. Hepatitis B surface antigen (HBsAg) and HBV DNA were tested every 6 months.

RESULTS:

The study cohort is composed of 157 men and 19 women, mean age 47.9 ± 10.1 years, all HBsAg positive, 35 (19.8%) had HBV DNA >2000 IU/mL before LT. After LT, patients received entecavir (n = 126, 71.5%), tenofovir (n = 20, 11.3%), or a combination of entecavir and tenofovir (n = 30, 17% for 3 months), followed by entecavir alone. During follow-up of 43 (12-117) months, 2 patients (including 1 with non-compliance) had HBV recurrence.

CONCLUSION:

In a large cohort of LDLT recipients for HBV-related liver disease, use of low-dose short-term HBIG with high genetic barrier drugs results in a substantially lower incidence of HBV recurrence, even in high-risk patients.

• Authors: N S Choudhary, N Saraf, S Saigal, R Mohanka, A Rastogi, S Goja, P B Menon, A S Soin
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 17 Issue 3 Pg. 329-33 (Jun 2015) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 25682715 (Publication Type: Journal Article)
• Copyright: © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents
• Hepatitis B Surface Antigens
• Immunoglobulins
• Organophosphonates
• Lamivudine
• entecavir
• Guanine
• adefovir
• Tenofovir
• Adenine
• hepatitis B hyperimmune globulin

Topics

• Adenine (administration & dosage, analogs & derivatives)
• Adult
• Antiviral Agents (administration & dosage)
• Carcinoma, Hepatocellular (prevention & control, virology)
• Cohort Studies
• Drug Resistance, Viral
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Guanine (administration & dosage, analogs & derivatives)
• Hepatitis B (prevention & control, virology)
• Hepatitis B Surface Antigens (immunology)
• Hepatitis B virus (genetics, immunology)
• Humans
• Immunoglobulins (administration & dosage)
• Lamivudine (administration & dosage)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Organophosphonates (administration & dosage)
• Prospective Studies
• Recurrence
• Tenofovir (administration & dosage)