Nucleoside-Nucleotide Analog Combination Therapy Is Effective in Preventing Recurrent Hepatitis B After Liver Transplantation.

Abstract

BACKGROUND:

Hepatitis B immune globulin (HBIg) in combination with a nucleos(t)ide analog is the mainstay of prophylactic regimen to prevent recurrence of hepatitis B following orthotopic liver transplantation (OLT). HBIg therapy is costly and inconvenient for the patients. There is a growing experience converting HBIg/nucleos(t)ide to combination nucleotide/nucleoside analogs from.

METHODS:

Twenty-six patients that underwent OLT between March 2001 and July 2011 who had received at least 12 months of HBIg and single nucleos(t)ide were enrolled. HBsAg and HBV DNA were undetectable, and anti-HBs were detectable at the time of switch. HBV DNA and HBsAg were measured every 3 months following discontinuation of HBIg and addition of nucleos(t)ide.

RESULTS:

Patients included 23 Asians/3 Caucasian, 21 males/5 females. Mean time of conversion from HBIg/nucleos(t)ide to nucleoside/nucleotide combination was 77.5 (range 11-132) months after OLT. Mean duration of follow-up after conversion was 31.9 (range 14-70) months. All patients had undetectable HBV DNA, and 24 patients remained HBsAg negative during follow-up. Two patients recurred 7 and 9 months later, respectively, with detectable HBsAg. Both patients continued to have undetectable HBV DNA and normal ALT. HBsAg was neutralized by reinfusion of HBIg.

CONCLUSION:

Nucleoside/nucleotide combination is an effective alternative to HBIg/nucleos(t)ide to prevent recurrence of hepatitis B after OLT.

• Authors: Saro Khemichian, Mary J Hsieh, Shi-Rong Zhang, Joyce Limurti, John Kim, Tse-Ling Fong
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 60 Issue 9 Pg. 2807-12 (Sep 2015) ISSN: 1573-2568 [Electronic] United States
• PMID: 25939541 (Publication Type: Journal Article)

Chemical References

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

Topics

• Adenine (analogs & derivatives, therapeutic use)
• Adult
• Antiviral Agents (therapeutic use)
• DNA, Viral (blood)
• Drug Therapy, Combination
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B (prevention & control)
• Hepatitis B Surface Antigens (blood)
• Hepatitis B virus (genetics, immunology)
• Humans
• Immunoglobulins (therapeutic use)
• Lamivudine (therapeutic use)
• Liver Transplantation
• Male
• Middle Aged
• Organophosphonates (therapeutic use)
• Prospective Studies
• Recurrence
• Tenofovir