Nucleos(t)ide analog(s) prophylaxis after hepatitis B immunoglobulin withdrawal against hepatitis B and D recurrence after liver transplantation

• Published in: Transplant infectious disease 2016-10, Vol.18 (5), p.667-673
• Main Authors: Cholongitas, E., Goulis, I., Antoniadis, N., Fouzas, I., Imvrios, G., Giakoustidis, D., Giouleme, O., Papanikolaou, V., Akriviadis, E., Vasiliadis, T.
• Format: Article
• Language: English
• Subjects: Adenine - administration & dosage; Adenine - adverse effects; Adenine - analogs & derivatives; Adenine - therapeutic use; Adult; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Coinfection - complications; Coinfection - prevention & control; DNA, Viral - isolation & purification; Drug Therapy, Combination; entecavir; Female; glomerular filtration rate; Guanine - administration & dosage; Guanine - adverse effects; Guanine - analogs & derivatives; Guanine - therapeutic use; hepatitis B and D co-infection; hepatitis B recurrence; Hepatitis B virus - isolation & purification; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - prevention & control; hepatitis D; Hepatitis D, Chronic - complications; Hepatitis D, Chronic - prevention & control; Humans; Immunoglobulins - administration & dosage; Immunoglobulins - therapeutic use; Lamivudine - administration & dosage; Lamivudine - adverse effects; Lamivudine - therapeutic use; Liver Cirrhosis - drug therapy; Liver Cirrhosis - surgery; Liver Cirrhosis - therapy; Liver Transplantation; Male; Middle Aged; Organophosphonates - administration & dosage; Organophosphonates - adverse effects; Organophosphonates - therapeutic use; renal function; Secondary Prevention - methods; tenofovir; Tenofovir - administration & dosage; Tenofovir - adverse effects; Tenofovir - therapeutic use; Treatment Outcome; Withholding Treatment; Young Adult
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12575

Background/aims Nucleos(t)ide analogs (NAs) have made a hepatitis B immunoglobulin (HBIG)‐sparing protocol an attractive approach against hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, this approach is considered controversial in patients transplanted for HBV and hepatitis D (HDV) co‐infection. Material/Methods All patients transplanted for HBV/HDV cirrhosis were evaluated. After LT, each patient received HBIG + NAs and then continued with NAs prophylaxis. All patients were followed up with HBV serum markers and HBV DNA, while anti‐HDV/HDV RNA was performed in those with HBV recurrence. Results A total of 34 recipients were included (22 men, age: 46.7 ± 16 years). After HBIG discontinuation, NAs were received as monoprophylaxis (lamivudine [LAM]: 2, adefovir [AFV]: 1, entecavir: 9, tenofovir [TDF]: 12) or dual prophylaxis (LAM + AFV [or TDF]: 10 patients). Two (5.8%) of the 34 patients had HBV/HDV recurrence after HBIG withdrawal (median follow‐up: 28 [range, 12–58] months). These 2 patients had undetectable HBV DNA at LT. Statistical analysis revealed that those with recurrence had received HBIG for shorter period, compared to those without recurrence (median: 9 vs. 28 months, P = 0.008). Conclusions We showed for the first time, to our knowledge, that maintenance therapy with NAs prophylaxis after HBIG discontinuation was effective against HBV/HDV recurrence, but it seems that a longer period of HBIG administration might be needed before it is withdrawn after LT.