Impact of virologic breakthrough and HBIG regimen on hepatitis b recurrence after liver transplantation

B. Degertekin, Steven Huy B. Han, E. B. Keeffe, E. R. Schiff, V. A. Luketic, R. S. Brown, S. Emre, C. Soldevila-Pico, K. R. Reddy, M. B. Ishitani, T. T. Tran, T. L. Pruett, A. S.F. Lok

Research output: Contribution to journalArticle

80 Scopus citations

Abstract

The availability of hepatitis B immune globulin (HBIG) and several oral antiviral therapies has reduced but not eliminated hepatitis B virus (HBV) recurrence. We aimed to determine the rate of HBV recurrence after orthotopic liver transplantation (OLT) in relation to virologic breakthrough pre-OLT and HBIG regimens post-OLT. Data from the NIH HBV-OLT database were analyzed. A total of 183 patients transplanted between 2001 and 2007 followed for a median of 42 months (range 1-81) post-OLT were studied. At transplant, 29% were hepatitis B e antigen (HBeAg) (+), 38.5% had HBV DNA > 5 log10 copies/mL, 74% were receiving antiviral therapy. Twenty-five patients experienced virologic breakthrough before OLT. Post-OLT, 26%, 22%, 40% and 12% of patients received intravenous (IV) high-dose, IV low-dose, intramuscular low-dose and a finite duration of HBIG, respectively as maintenance prophylaxis. All but two patients also received antiviral therapy. Cumulative rates of HBV recurrence at 1 and 5 years were 3% and 9%, respectively. Multivariate analysis showed that listing HBeAg status and HBV DNA level at OLT were the only factors associated with HBV recurrence. In conclusion, low rates of HBV recurrence can be accomplished with all the HBIG regimens used when combined with antiviral therapy including patients with breakthrough pre-OLT as long as rescue therapy is administered pre- and post-OLT.

Original languageEnglish (US)
Pages (from-to)1823-1833
Number of pages11
JournalAmerican Journal of Transplantation
Volume10
Issue number8
DOIs
StatePublished - Aug 2010

Keywords

  • Adefovir
  • HBV DNA
  • antiviral resistance
  • hepatitis B e antigen
  • lamivudine

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    Degertekin, B., Han, S. H. B., Keeffe, E. B., Schiff, E. R., Luketic, V. A., Brown, R. S., Emre, S., Soldevila-Pico, C., Reddy, K. R., Ishitani, M. B., Tran, T. T., Pruett, T. L., & Lok, A. S. F. (2010). Impact of virologic breakthrough and HBIG regimen on hepatitis b recurrence after liver transplantation. American Journal of Transplantation, 10(8), 1823-1833. https://doi.org/10.1111/j.1600-6143.2010.03046.x