title: Entecavir monotherapy is effective in suppressing hepatitis B virus after liver transplantation.
abstract: OBJECTIVE
  We investigated the efficacy of entecavir, a cyclopentyl guanosine nucleoside analogue, as monoprophylaxis in patients with chronic hepatitis B who received a liver transplant.
  
  
  METHODS
  We studied data from 80 consecutive patients who received a liver transplant (47 from living donors and 33 from deceased donors) for hepatitis B-related disease and entecavir monotherapy as prophylaxis. None of the patients received hepatitis B immunoglobulin. Indications for transplant included decompensation from cirrhosis (27.5%), acute-on-chronic hepatitis B (47.5%), and hepatocellular carcinoma (25%). The median follow-up time was 26 months (range, 5-40 months). Before transplant, 33 patients were not on antiviral therapy and 47 were on oral therapy (18 had received less than 3 months of treatment).
  
  
  RESULTS
  At the time of transplant, the median log HBV DNA level was 3.5 copies/mL (range, 1.54-8.81); 21 patients (26%) had undetectable levels of HBV DNA. The cumulative rate of hepatitis B surface antigen (HBsAg) loss was 86% and 91% after 1 and 2 years, respectively. Ten patients had reappearance of HBsAg. Eighteen patients (22.5%) were HBsAg positive at the time of their last examination; 17 of these had undetectable levels of HBV DNA, and the remaining patient had a low level of HBV DNA (217 copies/mL). There was no evidence of mutations at sites that confer resistance to entecavir among patients who were HBsAg positive.
  
  
  CONCLUSIONS
  Although only 26% of patients had complete viral suppression at the time of transplant, 91% lost HBsAg, with 98.8% achieving undetectable levels of HBV DNA. A hepatitis B immunoglobulin-free regimen of entecavir monotherapy is effective after liver transplantation for chronic hepatitis B.
authors.affiliation: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
authors.forename: James
authors.initials: J
authors.lastname: Fung
authors.forename: Cindy
authors.initials: C
authors.lastname: Cheung
authors.forename: See-Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: William
authors.initials: W
authors.lastname: Sharr
authors.forename: Wing-Chiu
authors.initials: WC
authors.lastname: Dai
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.forename: Tan-To
authors.initials: TT
authors.lastname: Cheung
authors.forename: Simon
authors.initials: S
authors.lastname: Tsang
authors.forename: Banny
authors.initials: B
authors.lastname: Lam
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Lai
authors.forename: Chung-Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000821:virology; D016009:Chi-Square Distribution; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D006723:Hong Kong; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; C413685:entecavir; D006147:Guanine