Posttransplantation Hepatitis B Prophylaxis with Combination Oral Nucleoside and Nucleotide Analog Therapy

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http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2010.03416.x/abstract

Posttransplantation Hepatitis B Prophylaxis with Combination Oral Nucleoside and

Nucleotide Analog Therapy

S. Saab1,2,*,†, S. Desai1,†, D. Tsaoi1, F. Durazo1,2, S. Han1,2, A. McClune1,2,

C. Holt2, D. Farmer2, L. Goldstein2, R. W. Busuttil2

Article first published online: 7 FEB 2011

DOI: 10.1111/j.1600-6143.2010.03416.x

©2011 The Authors Journal compilation©2011 The American Society of

Transplantation and the American Society of Transplant Surgeons

Issue

American Journal of Transplantation

Volume 11, Issue 3, pages 511–517, March 2011

Abstract

Liver transplant recipients are at risk of developing recurrent hepatitis B

after liver transplantation for hepatitis B virus (HBV)-related liver disease.

We evaluated the efficacy of a new hepatitis B prophylaxis regimen involving

conversion from at least 12 months of HBIg with lamivudine to combination

therapy with an oral nucleoside and nucleotide analog. Between June 2008 and May

2010, a total of 61 liver transplant recipients were converted to a combination

of a nucleoside and nucleotide analog. The mean (±standard deviation) follow-up

time after conversion was 15.0 (±6.1) months. Recurrent HBV occurred in two

(3.3%) patients at 3.1 and 16.6 months after HBIg cessation. The overall person

time incidence rate for HBV recurrence after HBIg cessation was 2.7 cases per

100 person-years. The estimate of HBV recurrence was 1.7% at 1 year after HBIg

cessation. HBIg cessation a minimum of 12 months after liver transplantation

with subsequent combination therapy with a nucleoside and nucleotide analog

provides effective prophylaxis against recurrent HBV infection. The clinical

implications of HBsAg detection without clinical, biochemical or molecular

manifestations of recurrent hepatitis B require further study.