Impact of Virologic Breakthrough and HBIG Regimen on Hepatitis B Recurrence After Liver Transplantation |
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| Authors: | B Degertekin Steven‐Huy B Han E B Keeffe E R Schiff V A Luketic R S Brown Jr S Emre C Soldevila‐Pico K R Reddy M B Ishitani T T Tran T L Pruett A S F Lok the NIH HBV‐OLT Study Group |
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| Institution: | 1. Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI;2. University of California, Los Angeles, CA;3. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA;4. University of Miami, Miami, FL;5. Virginia Commonwealth University, Richmond, VA;6. Columbia Presbyterian Medical Center, New York, NY;7. Yale University School of Medicine, New Haven, CT;8. University of Florida, Gainesville, FL;9. University of Pennsylvania, Philadelphia, PA;10. Mayo Clinic, Rochester, MN;11. Cedars Sinai Medical Center, Los Angeles, CA;12. University of Virginia, Charlottesville, VA |
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| Abstract: | 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. |
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| Keywords: | Adefovir antiviral resistance HBV DNA hepatitis B e antigen lamivudine |
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