title: Prevention and risk factors of hepatitis B recurrence after living donor liver transplantation.
abstract: OBJECTIVE
  Without effective prophylaxis, liver transplantation (LT) for hepatitis B virus (HBV)-related liver disease is frequently complicated by severe and rapidly progressive HBV recurrence. The combination of low-dose hepatitis B immunoglobulin (HBIG) and the new nucleos(t)ide analog, entecavir, as prophylaxis for HBV recurrence after living-donor LT (LDLT) were analyzed.
  
  
  METHODS
  A total of 315 patients with positive hepatitis B surface antigen underwent LDLT at our transplant center between July 2003 and December 2011. Our protocol for post-transplantation HBV prophylaxis was a combination of low-dose HBIG and nucleos(t)ide analog.
  
  
  RESULTS
  During a median follow-up period of 49 months post-transplant, 10 patients (3.2%) had HBV recurrence, which was significantly related to hepatocellular carcinoma (HCC) at transplantation (P = 0.041) and post-LT antiviral agent (P < 0.001) in multivariate analysis. The level of HBV DNA and hepatitis B e antigen state at transplantation were not significant factors for HBV recurrence (P = 0.342 and P = 0.802, respectively). In 170 patients with HCC at LDLT, HCC recurrence was significantly related to HBV recurrence (P < 0.001). Among 10 patients with HBV recurrence, three are alive and two had lost hepatitis B surface antigen. The remaining seven patients died of HCC recurrence.
  
  
  CONCLUSIONS
  The combination of low-dose HBIG and nucleos(t)ide analogs is safe and effective for HBV prophylaxis after LDLT. As a post-LT antiviral treatment, entecavir is more effective than lamivudine. HCC at transplantation was significantly associated with HBV recurrence. HBV-related HCC patients who undergo LDLT require close virological monitoring.
authors.affiliation: Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Gun Hyung
authors.initials: GH
authors.lastname: Na
authors.forename: Dong Goo
authors.initials: DG
authors.lastname: Kim
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Han
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Soo Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Hong
authors.forename: Young Kyoung
authors.initials: YK
authors.lastname: You
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006509:Hepatitis B / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009711:Nucleotides / Q000008:administration & dosage*; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D009711:Nucleotides; C413685:entecavir; D006147:Guanine; C045213:hepatitis B hyperimmune globulin
keywords: entecavir; hepatitis B immunoglobulin; hepatitis B virus; hepatocelluar carcinoma; liver transplantation; nucleos(t)ide analog