title: Nucleoside plus nucleotide analogs and cessation of hepatitis B immunoglobulin after liver transplantation in chronic hepatitis B is safe and effective.
abstract: BACKGROUND
  After orthotopic liver transplantation (OLT) in chronic hepatitis B (HBV), adequate prophylaxis for recurrence of HBV in the graft is mandatory.
  
  
  OBJECTIVE
  Evaluate safety of HBV prophylaxis with tenofovir and emtricitabine (TDF/FTC) after cessation of hepatitis B immunoglobulin (HBIG) after OLT in chronic HBV.
  
  
  METHODS
  In 17 consecutive patients after OLT in chronic HBV we started TDF/FTC after cessation of HBIG. All had received HBIG >6 months. 15/17 were HBsAg negative and 16/17 had undetectable HBV-DNA.
  
  
  RESULTS
  After mean follow-up of 2 years 16/17 patients were alive, one died due to urosepsis. All 16 with undetectable HBV-DNA remained HBV-DNA negative. From 15 HBsAg negative patients at start, in one seroconversion to positive HBsAg occurred, without detectable HBV-DNA. Liver biochemistry remained within the normal ranges. There were no cases of drug discontinuation. No major side effects were reported. TDF/FTC use saves €16,262/year over standard-of-care (HBIG+LAM). This prospective follow-up study shows that in liver transplantation for chronic hepatitis B, after initial treatment including HBIG for at least 6 months combined with or followed by (dual) nucleos(t)ide analog therapy, TDF/FTC provides adequate prophylaxis against recurrent HBV infection without major side effects and leads to substantial cost savings over a regimen with HBIG.
  
  
  CONCLUSIONS
  Combined prophylaxis with TDF/ETV nucleoside plus nucleotide analogs and cessation of immunoglobulin after liver transplantation in chronic hepatitis B is safe and effective.
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: D J W
authors.initials: DJ
authors.lastname: Wesdorp
authors.forename: M
authors.initials: M
authors.lastname: Knoester
authors.forename: A E
authors.initials: AE
authors.lastname: Braat
authors.forename: M J
authors.initials: MJ
authors.lastname: Coenraad
authors.forename: A C T M
authors.initials: AC
authors.lastname: Vossen
authors.forename: E C J
authors.initials: EC
authors.lastname: Claas
authors.forename: B
authors.initials: B
authors.lastname: van Hoek
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018890:Chemoprevention / Q000379:methods; D015331:Cohort Studies; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004359:Drug Therapy, Combination / Q000379:methods; D000068679:Emtricitabine; D005260:Female; D006510:Hepatitis B Antibodies / Q000008:administration & dosage* / Q000009:adverse effects; D019694:Hepatitis B, Chronic / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D000068698:Tenofovir; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D063065:Organophosphonates; D003841:Deoxycytidine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine
keywords: ADV; ALT; AST; ETV; Emtricitabine; FTC; GFR; HBIG; HBV; HBeAg; HBsAg; HCV; HDV; HIV; Hepatitis B; IU; Immunoglobulin; LAM; LAMr; Liver transplantation; MDRD; OLT; Prevention; TDF; TDF/FTC; Tenofovir; adefovir; alanine aminotransferase; anti-HBe; anti-HBs; aspartate aminotransferase; emtricitabine; entecavir; glomerular filtration rate; hepatitis B e antibody; hepatitis B e antigen; hepatitis B immunoglobulin; hepatitis B surface antibody; hepatitis B surface antigen; hepatitis B virus; hepatitis C virus; hepatitis delta virus; human immunodeficiency virus; international units; lamivudine; lamivudine resistance; modification of diet in renal disease; orthotopic liver transplantation; tenofovir; tenofovir and emtricitabine