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.
Victorian Liver Transplant Unit, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia. scott.patterson@austin.org.au
Scott J
SJ
Patterson
Peter W
PW
Angus
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