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

作者：Cholongitas E^*; Goulis I; Antoniadis N; Fouzas I; Imvrios G; Giakoustidis D; Giouleme O; Papanikolaou V; Akriviadis E; Vasiliadis T

来源：Transplant Infectious Disease, 2016, 18(5): 667-673.

DOI：10.1111/tid.12575

• liver transplantation
• hepatitis D
• hepatitis B and D co-infection
• hepatitis B recurrence
• entecavir
• tenofovir
• renal function
• glomerular filtration rate

Background/aimsNucleos(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/MethodsAll 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.
ResultsA 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).
ConclusionsWe 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against HBV/HDV recurrence, but it seems that a longer period of HBIG administration might be needed before it is withdrawn after LT.

• 出版日期2016-10