Prevention and Risk Factors of Hepatitis B Recurrence after Living Donor Liver Transplantation

J Gastroenterol Hepatol. 2013 Oct 3. doi: 10.1111/jgh.12403. [Epub ahead of print]

Na GH, Kim DG, Han JH, Kim EY, Lee SH, Hong TH, You YK, Choi JY.

Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Abstract

BACKGROUND AND AIM: Without effective prophylaxis, liver transplantation (LT) for hepatitis B virus (HBV)-related liver disease is frequently complicated by severe and rapidly progressive HBV recurrence. We analyzed the combination of low-dose hepatitis B immunoglobulin (HBIG) and the new nucleos(t)ide analogue, entecavir, as prophylaxis for HBV recurrence after living donor liver transplantation (LDLT).

METHODS: A total of 315 patients with positive hepatitis B surface antigen (HBsAg) underwent LDLT at our transplant center between July 2003 and December 2011. Our protocol for post-transplantation HBV prophylaxis was a combination of low-dose HBIG and nucleos(t)ide analogues.

RESULTS: During a median follow-up period of 49 months post-transplant, 10 patients (3.2%) had HBV recurrence, which was significantly related to HCC at transplantation (p = 0.041) and post-LT antiviral agent (p < 0.001) in multivariate analysis. The level of HBV DNA and hepatitis B e antigen (HBeAg) state at transplantation were not significant factors for HBV recurrence (p = 0.342 and p = 0.802 respectively). In 170 patients with HCC at LDLT, HCC recurrence was significantly related to HBV recurrence (p < 0.001). Among 10 patients with HBV recurrence, three are alive and two had lost HBsAg. The remaining seven patients died of HCC recurrence.

CONCLUSIONS: The combination of low-dose HBIG and nucleos(t)ide analogues is safe and effective for HBV prophylaxis after LDLT. As a post-LT antiviral treatment, entecavir is more effective than lamivudine. HCC at transplantation was significantly associated with HBV recurrence. HBV-related HCC patients who undergo LDLT require close virological monitoring.

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KEYWORDS: Entecavir, Hepatitis B immunoglobulin, Hepatitis B virus, Hepatocelluar carcinoma, Liver transplantation, Nucleos(t)ide analogue

PMID: 24117684 [PubMed - as supplied by publisher]

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