Prevention and risk factors of hepatitis B recurrence after living donor liver transplantation

• Published in: Journal of gastroenterology and hepatology Vol. 29; no. 1; pp. 151 - 156
• Main Authors: Na, Gun Hyung, Kim, Dong Goo, Han, Jae Hyun, Kim, Eun Young, Lee, Soo Ho, Hong, Tae Ho, You, Young Kyoung, Choi, Jong Young
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.01.2014
• Subjects: Adult; Antiviral agents; Antiviral Agents - administration & dosage; Carcinoma, Hepatocellular - etiology; Carcinoma, Hepatocellular - surgery; Drug Therapy, Combination; entecavir; Female; Guanine - administration & dosage; Guanine - analogs & derivatives; Hepatitis B - complications; Hepatitis B - prevention & control; hepatitis B immunoglobulin; Hepatitis B virus; hepatocelluar carcinoma; Humans; Immunoglobulins - administration & dosage; Liver Neoplasms - etiology; Liver Neoplasms - surgery; Liver Transplantation; Living Donors; Male; Middle Aged; nucleos(t)ide analog; Nucleotides - administration & dosage; Risk Factors; Secondary Prevention; Treatment Outcome; entecavir; nucleos(t)ide analog; hepatitis B immunoglobulin; hepatitis B virus; hepatocelluar carcinoma; liver transplantation
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.12403

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. The combination of low‐dose hepatitis B immunoglobulin (HBIG) and the new nucleos(t)ide analog, entecavir, as prophylaxis for HBV recurrence after living‐donor LT (LDLT) were analyzed. Methods A total of 315 patients with positive hepatitis B surface antigen 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 analog. Results During a median follow‐up period of 49 months post‐transplant, 10 patients (3.2%) had HBV recurrence, which was significantly related to hepatocellular carcinoma (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 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 hepatitis B surface antigen. The remaining seven patients died of HCC recurrence. Conclusions The combination of low‐dose HBIG and nucleos(t)ide analogs 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.