Substitution of tenofovir/emtricitabine for Hepatitis B immune globulin prevents recurrence of Hepatitis B after liver transplantation

• Published in: Liver international 2012-08, Vol.32 (7), p.1138-1145
• Main Authors: Todd Stravitz, R., Shiffman, Mitchell L., Kimmel, Melissa, Puri, Puneet, Luketic, Velimir A., Sterling, Richard K., Sanyal, Arun J., Cotterell, Adrian H., Posner, Marc P., Fisher, Robert A.
• Format: Article
• Language: English
• Subjects: Adenine - analogs & derivatives; Adenine - economics; Adenine - therapeutic use; Adult; Antiviral Agents - economics; Antiviral Agents - therapeutic use; antiviral therapy; Biopsy; Deoxycytidine - analogs & derivatives; Deoxycytidine - economics; Deoxycytidine - therapeutic use; DNA; Emtricitabine; Female; HBV DNA polymerase inhibitor; Hepatitis B; Hepatitis B - economics; Hepatitis B - prevention & control; Hepatitis B - surgery; Hepatitis B surface antigen; Hepatitis B virus; Humans; Immunoglobulins; Immunoglobulins - economics; Immunoglobulins - therapeutic use; Lamivudine; Liver Transplantation; Male; Middle Aged; Necrosis; nucleo(s)tide analogue; Organophosphonates - economics; Organophosphonates - therapeutic use; Renal failure; Renal function; Secondary Prevention; Side effects; Tenofovir
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/j.1478-3231.2012.02770.x

Background Hepatitis B immune globulin (HBIg) with or without nucleos(t)ide analogue (NA) inhibitors has been shown to prevent recurrence of hepatitis B virus (HBV) following orthotopic liver transplantation (OLT). However, the use of HBIg has many disadvantages. Aims The present study was performed to determine if converting patients from HBIg±NA to combination NA therapy could prevent recurrence of HBV. Methods Twenty‐one recipients without evidence of HBV recurrence on HBIg±NA for ≥6 months were enrolled. Patients received their last injection of HBIg at the time they initiated tenofovir disoproxil fumarate/emtricitabine (TDF/FTC; Truvada®) and were followed up for 31.1 ± 9.0 [range 15–47] months. Results After 1 year, 3 patients (14%) had detectable HBsAg, one of whom was non‐compliant. Two of 3 with recurrence cleared HBsAg by last follow‐up on TDF/FTC; the non‐compliant patient became HBV DNA‐undetectable with re‐institution of TDF/FTC. TDF/FTC saved $12,469/year over our standard‐of‐care, monthly intramuscular HBIg/lamivudine. There was no evidence of a general adverse effect of TDF/FTC on renal function. However, 3 patients developed reversible acute renal failure; on renal biopsy, 1 had possible TDF/FTC‐induced acute tubular necrosis. Conclusions Substitution of TDF/FTC for HBIg prevented recurrence of HBV DNA in 100% (20/20) of patients who were compliant with the medication and led to substantial cost savings over HBIg‐containing regimens.