Post-liver transplant hepatitis B prophylaxis: the role of oral nucleos(t)ide analogues.
OBJECTIVE
The established gold standard for prophylaxis against hepatitis B virus (HBV) recurrence post-liver transplant is combination hepatitis B immune globulin (HBIG) and lamivudine. This therapy reduces the risk of recurrence to less than 5% at 5 years; however, the cost of HBIG has led to the investigation of alternatives. This paper reviews the HBIG-sparing alternatives achieved with lamivudine and the prospects for the newer anti-HBV agents in post-liver transplant prophylaxis.


RESULTS
When used with lamivudine as part of combination prophylaxis, low-dose intramuscular HBIG is equivalent to high-dose intravenous HBIG. There is recent evidence that in patients receiving HBIG/lamivudine, HBIG can be replaced with adefovir dipivoxil at 6-12 months post-liver transplant without precipitating recurrence. Furthermore, a recent study showed that primary prophylaxis with combination adefovir/lamivudine therapy without the use of long-term HBIG was effective and well tolerated as primary prophylaxis.


CONCLUSIONS
Although there are few studies of potent newer anti-HBV agents such as entecavir or tenofovir being used as HBV prophylaxis, the properties of these drugs suggest that they should replace lamivudine within HBV prophylaxis regimes.
Patterson
Scott J
SJ
Victorian Liver Transplant Unit, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia. scott.patterson@austin.org.au
Angus
Peter W
PW
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000284:Administration, Oral; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006085:Graft Survival / Q000187:drug effects*; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006509:Hepatitis B / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D007273:Injections, Intramuscular; D019259:Lamivudine / Q000008:administration & dosage; D016031:Liver Transplantation / Q000009:adverse effects*; D009705:Nucleosides / Q000008:administration & dosage* / Q000009:adverse effects; D009711:Nucleotides / Q000008:administration & dosage* / Q000009:adverse effects; D063065:Organophosphonates / Q000008:administration & dosage; D055502:Secondary Prevention; D000068698:Tenofovir; D016896:Treatment Outcome
D000998:Antiviral Agents; D007136:Immunoglobulins; D009705:Nucleosides; D009711:Nucleotides; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine; C106812:adefovir dipivoxil; C045213:hepatitis B hyperimmune globulin