Prevention of recurrent hepatitis B virus infection after liver transplantation: hepatitis B immunoglobulin, antiviral drugs, or both? Systematic review and meta-analysis

• Published in: Transplant infectious disease 2010-08, Vol.12 (4), p.292-308
• Main Authors: Katz, L.H., Paul, M., Guy, D.G., Tur-Kaspa, R.
• Format: Article
• Language: English
• Subjects: adefovir; Adenine - analogs & derivatives; Adenine - therapeutic use; Adult; Antiviral agents; Antiviral Agents - therapeutic use; Cohort Studies; Controlled Clinical Trials as Topic; Drug Therapy, Combination; Hepatitis B; Hepatitis B - epidemiology; Hepatitis B - mortality; Hepatitis B - prevention & control; hepatitis B immune globulin; Hepatitis B Surface Antigens - blood; Hepatitis B Surface Antigens - drug effects; Hepatitis B virus; Hepatitis B virus - immunology; Humans; Immunoglobulins; Immunoglobulins - therapeutic use; Immunosuppressive agents; lamivudine; Lamivudine - therapeutic use; liver transplantation; Liver Transplantation - adverse effects; Middle Aged; Organophosphonates - therapeutic use; prevention; Randomized Controlled Trials as Topic; Recurrent infection; Reviews; Secondary Prevention; Treatment Outcome
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/j.1399-3062.2009.00470.x

L.H. Katz, M. Paul, D.G. Guy, R. Tur‐Kaspa. Prevention of recurrent hepatitis B virus infection after liver transplantation: hepatitis B immunoglobulin, antiviral drugs, or both? Systematic review and meta‐analysis.
Transpl Infect Dis 2009: 12: 292–308. All rights reserved : Objectives. To evaluate antiviral prophylaxis against hepatitis B virus (HBV) following liver transplantation. Methods. Systematic review and meta‐analysis. Clinical trials and comparative cohort studies comparing the use of hepatitis B immunoglobulin (HBIg), antivirals, or both following liver transplantation for HBV infection were included. The primary outcome was reappearance of hepatitis B surface antigen (HBsAg). Other outcomes included all‐cause and HBV‐related mortality, HB‐related active liver disease, and reappearance of HBV DNA after transplantation. Relative risks (RR) with 95% confidence intervals (CIs) are reported. Results. Twenty studies (22 comparisons) were included. Ten studies compared HBIg to combination treatment, 9 compared antivirals to combination treatment, and 3 compared lamivudine (LAM) to HBIg. Combination treatment reduced HBsAg reappearance (RR 0.28; 95% CI 0.12–0.66), and was superior to HBIg alone in all other outcome measures. Combination treatment was significantly better than antivirals in preventing reappearance of HBsAg (RR 0.31; 95% CI 0.22–0.44), even when low‐dose HBIg was given. No significant difference was found between HBIg and LAM monotherapy for all measured outcomes. Major limitations with regard to comparability of the study groups in non‐randomized trials were revealed. Conclusions. Combination treatment with HBIg and LAM reduced HBV recurrence following liver transplantation, compared with HBIg or LAM alone, and reduced mortality compared with HBIg alone.