Prophylaxis against de novo hepatitis B for liver transplantation utilizing hep B core (+) donors: does hepatitis B immunoglobulin provide a survival advantage?

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2011.01236.x/abstract

ORIGINAL ARTICLE

Prophylaxis against de novo hepatitis B for liver transplantation utilizing hep

B core (+) donors: does hepatitis B immunoglobulin provide a survival advantage?

Guy N. Brock1, Farida Mostajabi1, Ferguson1, J. Carrubba2,

Eng2, ph F. Buell2, R. Marvin2

Article first published online: 15 MAR 2011

DOI: 10.1111/j.1432-2277.2011.01236.x

© 2011 The Authors. Transplant International © 2011 European Society for Organ

Transplantation

Issue

Transplant International

Early View (Articles online in advance of print)

Summary

Donor liver allografts with positive serology for hepatitis B core antibody [HBc

(+)] have been increasingly used for liver transplantation. However, the optimal

prophylactic regimen to prevent development of de novo hepatitis B has not been

determined. To evaluate this, we screened United Network for Organ Sharing

(UNOS) Standard Transplant Analysis and Research (STAR) registry data for adult

recipients of HBc (+) organs who were HBsAg (−), and evaluated the effects of

using prophylactic anti-viral therapies (HBIG and lamivudine) on patient and

graft survival. Out of a total cohort of 958 patients transplanted since 2004,

61 received HBIG alone, 116 received lamivudine alone, 66 both, 509 neither and

206 were missing this information. Based on several multivariable regression

models, patients receiving HBIG therapy-only were observed to have a

statistically significant (approximately 70%) reduction in risk of mortality

compared with patients receiving lamivudine-only therapy [hr = 0.29, 95% CI

(0.10, 0.86), P = 0.026], and a nonstatistically significant reduction in risk

of graft failure. However, no graft failures were attributed to de novo

hepatitis B, suggesting that any improved graft/patient survival possibly

associated with HBIG therapy occurs independently of de novo hepatitis B virus

(HBV) reduction. While this study cannot prove that HBIG therapy is protective

for graft and patient survival after liver transplantation, these findings do

highlight the need to further examine and study prophylactic use in recipients

of HBc (+) donors.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2011.01236.x/abstract

ORIGINAL ARTICLE

Prophylaxis against de novo hepatitis B for liver transplantation utilizing hep

B core (+) donors: does hepatitis B immunoglobulin provide a survival advantage?

Guy N. Brock1, Farida Mostajabi1, Ferguson1, J. Carrubba2,

Eng2, ph F. Buell2, R. Marvin2

Article first published online: 15 MAR 2011

DOI: 10.1111/j.1432-2277.2011.01236.x

© 2011 The Authors. Transplant International © 2011 European Society for Organ

Transplantation

Issue

Transplant International

Early View (Articles online in advance of print)

Summary

Donor liver allografts with positive serology for hepatitis B core antibody [HBc

(+)] have been increasingly used for liver transplantation. However, the optimal

prophylactic regimen to prevent development of de novo hepatitis B has not been

determined. To evaluate this, we screened United Network for Organ Sharing

(UNOS) Standard Transplant Analysis and Research (STAR) registry data for adult

recipients of HBc (+) organs who were HBsAg (−), and evaluated the effects of

using prophylactic anti-viral therapies (HBIG and lamivudine) on patient and

graft survival. Out of a total cohort of 958 patients transplanted since 2004,

61 received HBIG alone, 116 received lamivudine alone, 66 both, 509 neither and

206 were missing this information. Based on several multivariable regression

models, patients receiving HBIG therapy-only were observed to have a

statistically significant (approximately 70%) reduction in risk of mortality

compared with patients receiving lamivudine-only therapy [hr = 0.29, 95% CI

(0.10, 0.86), P = 0.026], and a nonstatistically significant reduction in risk

of graft failure. However, no graft failures were attributed to de novo

hepatitis B, suggesting that any improved graft/patient survival possibly

associated with HBIG therapy occurs independently of de novo hepatitis B virus

(HBV) reduction. While this study cannot prove that HBIG therapy is protective

for graft and patient survival after liver transplantation, these findings do

highlight the need to further examine and study prophylactic use in recipients

of HBc (+) donors.