title: Prophylaxsis against recurrance of hepatitis B virus after liver transplantation: a retrospective analysis spanning 20 years.
abstract: Liver transplantation (LT) in patients with hepatitis B virus (HBV) infection is associated with a high rate of graft loss and poor survival, unless re-infection can be prevented. Human hepatitis B immune globulin (HBIG) has long been utilized to prevent re-infection. More recently, an anti-viral agent has been utilized along with HBIG. However, the regimens utilized have varied considerably among LT programmes and the optimal regimen has never been defined. We conducted a retrospective analysis of 41 patients who underwent LT for HBV at our centre since 1985 and received either HBIG with or without an anti-viral agent. The mean age of these patients was 46 years; 81% were male and 88% white. The mean and maximal follow-up were 5.9 and 15 years respectively. Eight out of 15 E-antigen-positive patients who received HBIG alone developed recurrence after a mean of 17 months. In contrast, none of 10 E-Ag-negative patients who received HBIG alone and none of the 10 E-antigen-positive patients who received both HBIG and either lamivudine or adefovir developed recurrence. As long as the anti-HB surface remained detectable, no absolute minimum serum level appeared to lead to recurrent HBV. We concluded that recurrence of HBV following LT can be prevented in E-antigen-positive patients with a combination of HBIG and an anti-viral agent. In contrast, recurrence can be prevented in E-antigen-negative patients with HBIG alone. Maintaining a serum anti-HB surface level above a minimum arbitrary titre of 200 pg/mL did not appear to be necessary for effective HBIG prophylaxis.
authors.affiliation: Hepatology Section, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
authors.forename: Nevin
authors.initials: N
authors.lastname: Yilmaz
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.forename: R
authors.initials: R
authors.lastname: Todd Stravitz
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Daniel
authors.initials: D
authors.lastname: Maluf
authors.forename: Adrian
authors.initials: A
authors.lastname: Coterell
authors.forename: Marc P
authors.initials: MP
authors.lastname: Posner
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control* / Q000601:surgery*; D006513:Hepatitis B e Antigens / Q000097:blood; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D019259:Lamivudine / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D012189:Retrospective Studies; D055502:Secondary Prevention; D014768:Virginia
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000225:Adenine; C045213:hepatitis B hyperimmune globulin