Hepatitis B immune globulin (
HBIG) is routinely used in
liver transplantation for hepatitis B virus (HBV)-related
liver disease. With potent oral
antivirals,
HBIG may not be required. We conducted a prospective trial to evaluate living related
liver transplantation (LRLT) without
HBIG. Eighty-nine patients with HBV-related
liver disease underwent LRLT between January 2005 and January 2012. All donors were vaccinated with the HBV
vaccine. All patients were given oral
antivirals for HBV before
transplantation. Patients with HBV
DNA levels ≤ 2000 IU/mL were not given
HBIG, and patients with HBV
DNA levels > 2000 IU/mL were given
HBIG. Recurrence was defined as HBV
DNA positivity 6 months after
transplantation. Seventy-five of the 89 patients who underwent LRLT for HBV-related
liver disease were not given
HBIG. Nineteen patients received a combination of
lamivudine and
adefovir, 42 received
entecavir, 12 received
tenofovir, and 2 received a combination of
entecavir and
tenofovir. At the last follow-up (median = 21 months, range = 1-83 months), all patients were HBV
DNA-negative. Sixty-six patients cleared
hepatitis B surface antigen (
HBsAg), and 19 patients formed antibody to
hepatitis B surface antigen (anti-HBs). The cumulative probabilities of clearing
HBsAg were 90% and 92% at 1 and 2 years after
transplantation, respectively. Nine patients were
HBsAg-positive with undetectable
DNA at the last follow-up. The recurrence rate in our series was 8% (6/75). Five of these 6 patients had stopped taking oral
antivirals, and 1 had
entecavir resistance. All recurrences were salvaged with changes in the oral
antivirals. The actuarial probability of survival in this cohort was 73.7% at 83 months. There was no mortality due to HBV recurrence. In conclusion, HBV prophylaxis with oral
antivirals and without
HBIG is safe and effective in LRLT. A majority of the patients will clear
HBsAg, and some will develop anti-HBs
antibodies.