title: Prophylaxis against hepatitis B virus recurrence after liver transplantation: a registry study.
abstract: OBJECTIVE
  To evaluate the prophylactic efficacy of hepatitis B immunoglobulin (HBIG) in combination with different nucleos(t)ide analogues.
  
  
  METHODS
  A total of 5333 hepatitis B surface antigen-positive patients from the China Liver Transplant Registry database were enrolled between January 2000 and December 2009. Low-dose intramuscular (im) HBIG combined with one nucleos(t)ide analogue has been shown to be very cost-effective in recent reports. Hepatitis B virus (HBV) prophylactic outcomes were compared based on their posttransplant prophylactic protocols [group A (n = 4684): im HBIG plus lamivudine; group B (n = 491): im HBIG plus entecavir; group C (n = 158): im HBIG plus adefovir dipivoxil]. We compared the related baseline characteristics among the three groups, including the age, male sex, Meld score at the time of transplantation, Child-Pugh score at the time of transplantation, HCC, pre-transplantation hepatitis B e antigen positivity, pre-transplantation HBV deoxyribonucleic acid (HBV DNA) positivity, HBV DNA at the time of transplantation, pre-transplantation antiviral therapy, and the duration of antiviral therapy before transplantation of the patients. We also calculated the 1-, 3- and 5-year survival rates and HBV recurrence rates according to the different groups. All potential risk factors were analyzed using univariate and multivariate analyses.
  
  
  RESULTS
  The mean follow-up duration was 42.1 ± 30.3 mo. The 1-, 3- and 5-year survival rates were lower in group A than in groups B (86.2% vs 94.4%, 76.9% vs 86.6%, 73.7% vs 82.4%, respectively, P < 0.001) and C (86.2% vs 92.5%, 76.9% vs 73.7%, 87.0% vs 81.6%, respectively, P < 0.001). The 1-, 3- and 5-year posttransplant HBV recurrence rates were significantly higher in group A than in group B (1.7% vs 0.5%, 3.5% vs 1.5%, 4.7% vs 1.5%, respectively, P = 0.023). No significant difference existed between groups A and C and between groups B and C with respect to the 1-, 3- and 5-year HBV recurrence rates. Pretransplant hepatocellular carcinoma, high viral load and posttransplant prophylactic protocol (lamivudine and HBIG vs entecavir and HBIG) were associated with HBV recurrence.
  
  
  CONCLUSIONS
  Low-dose intramuscular HBIG in combination with a nucleos(t)ide analogue provides effective prophylaxis against posttransplant HBV recurrence, especially for HBIG plus entecavir.
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Shen
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Guang-Qin
authors.initials: GQ
authors.lastname: Xiao
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Wang
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Xu
authors.affiliation: Shu Shen, Li Jiang, Guang-Qin Xiao, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002681:China; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000009:adverse effects; D007273:Injections, Intramuscular; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin
keywords: Hepatitis B immunoglobulin; Liver transplantation; Nucleos(t)ide analogue; Recurrence; Viral hepatitis