title: Excellent liver transplantation survival and prevention of hepatitis B recurrence using hepatitis B immunoglobulin and nucleoside or nucleotide analogue along with treating physician adherence to treatment protocol.
abstract: BACKGROUND
  The introduction of hepatitis B immunoglobulin (HBIG) in the early 1990s dramatically reduced recurrence of hepatitis B after orthotopic liver transplantation (OLT) and thus improved survival. Today a combination of HBIG and a nucleoside or nucleotide analogue (NUC) is recommended as prophylaxis. The optimal protocol is yet to be commonly agreed upon. The aim of this study was to review our results over 25 years.
  
  
  METHODS
  All 56 patients (45 males and 11 females) who underwent OLT due to hepatitis B infection between 1985-2009 were included in the review. Median age at transplantation was 51 years (range, 18-66). Seventeen patients (30%) had hepatocellular carcinoma (HCC) at transplantation.
  
  
  RESULTS
  The 1- and 5-year overall survival rates were 89% and 77%, respectively. The 23 patients who underwent transplantation before 2000 showed 1- and 5-year survival rates of 82% and 61%, respectively; the 33 who underwent transplantation between 2000 and 2009, the rates were 94% and 90%, respectively (P < .01). There was no difference in the 5-year survival rate between patients who had or did not have been HCC (75% vs 78%, respectively). Recurrence of hepatitis B, defined as seroconversion to HBsAg positivity, was observed in 9 patients. Three transplantation cases before 1992 consequently did not receive HBIG. The remaining 6, who all underwent OLT between 1993 and 2001, were administered HBIG. In all 6 cases periods of low anti-HBs titers were registered prior to recurrence; treating physician noncompliance with the protocol may have contributed to the low anti-HBs titers. No recurrence was registered after 2001.
  
  
  CONCLUSIONS
  With a combination of HBIG and NUC, excellent OLT results can be achieved for hepatitis B. It is, however, still important to maintain sufficient anti-HBs titers to prevent recurrence.
authors.affiliation: Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden. christine_lindenger@yahoo.se
authors.forename: C
authors.initials: C
authors.lastname: Lindenger
authors.forename: M
authors.initials: M
authors.lastname: Castedal
authors.forename: C
authors.initials: C
authors.lastname: Cahlin
authors.forename: S
authors.initials: S
authors.lastname: Friman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D002985:Clinical Protocols; D005260:Female; D019983:Guideline Adherence; D006509:Hepatitis B / Q000503:physiopathology* / Q000517:prevention & control; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000008:administration & dosage; D009711:Nucleotides / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D009705:Nucleosides; D009711:Nucleotides