HBV DNA persistence 10 years after liver transplantation despite successful anti-HBS passive immunoprophylaxis.
Long-term immunoprophylaxis with hepatitis B immune globulin (HBIG) is widely accepted for the prevention of recurrent hepatitis B virus (HBV) infection after liver transplantation in HBV-infected patients without viral replication. We report long-term results of HBIG administration in 284 hepatitis B surface antigen (HBsAg)-positive transplant patients. In protocol 1, 259 patients were given HBIG with the goal of maintaining the anti-HBs antibody (Ab) titer over 100 IU/L. After December 1993, 25 HBV DNA-positive patients received HBIG, with a target anti-HBs Ab titer over 500 IU/L, combined with posttransplantation antiviral therapy (protocol 2). At 10 years, 44 patients without recurrence were tested for the presence of HBV DNA in serum using real-time polymerase chain reaction (PCR); 28 were also tested in liver and peripheral blood mononuclear cells (PBMC). The overall 5- and 10-year posttransplantation actuarial rates of HBV recurrence were 24.2% and 25.4%, respectively. The 5-year recurrence rate in protocol 2 patients was 11.8%. On multivariate analysis, predictors of lower HBV recurrence risk were absence of serum HBV DNA before transplantation (P <.0001), acute liver disease (P =.0037), HDV superinfection (P =.012), and protocol 2 therapy (P <.0001). Low-level HBV DNA was detected by PCR in 45.4% of patients without HBV recurrence at 10 years. Overall actuarial 10-year survival was 74.4%. In conclusion, we confirm the efficacy of long-term HBIG immunoprophylaxis. Combination prophylaxis with HBIG and antiviral therapy is effective in patients with viral replication. Although there were only a few cases of HBV recurrence after 5 years, HBV DNA remained present in 45% of patients at 10 years.
Roche
Bruno
B
Centre Hepato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
Feray
Cyrille
C
Gigou
Michele
M
Roque-Afonso
Anne Marie
AM
Arulnaden
Jean Louis
JL
Delvart
Valerie
V
Dussaix
Elisabeth
E
Guettier
Catherine
C
Bismuth
Henri
H
Samuel
Didier
D
D000328:Adult; D004279:DNA, Viral / Q000032:analysis / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000235:genetics; D006515:Hepatitis B virus / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D008099:Liver / Q000821:virology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055502:Secondary Prevention; D015996:Survival Rate; D016896:Treatment Outcome; D014779:Virus Replication
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin