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

TitleNucleos(t)ide analog(s) prophylaxis after hepatitis B immunoglobulin withdrawal against hepatitis B and D recurrence after liver transplantation.
Publication TypeJournal Article
Year of Publication2016
AuthorsCholongitas, E., Goulis I., Antoniadis N., Fouzas I., Imvrios G., Giakoustidis D., Giouleme O., Papanikolaou V., Akriviadis E., & Vasiliadis T.
JournalTranspl Infect Dis
Volume18
Issue5
Pagination667-673
Date Published2016 Oct
ISSN1399-3062
KeywordsAdenine, Adult, Antiviral Agents, Coinfection, DNA, Viral, Drug Therapy, Combination, Female, Guanine, Hepatitis B virus, Hepatitis B, Chronic, Hepatitis D, Chronic, Humans, Immunoglobulins, Lamivudine, Liver Cirrhosis, Liver Transplantation, Male, Middle Aged, Organophosphonates, Secondary Prevention, Tenofovir, Treatment Outcome, Withholding Treatment, Young Adult
Abstract

BACKGROUND/AIMS: Nucleos(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/METHODS: All 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.RESULTS: A 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).CONCLUSIONS: We 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.

DOI10.1111/tid.12575
Alternate JournalTranspl Infect Dis
PubMed ID27421122

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