title: Low-dose short-term hepatitis B immunoglobulin with high genetic barrier antivirals: the ideal post-transplant hepatitis B virus prophylaxis?
abstract: BACKGROUND
  Low-dose hepatitis B immunoglobulin (HBIG) and nucleos(t)ides analogs (lamivudine/adefovir) used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT) are associated with some risk of HBV recurrence and antiviral resistance.
  
  
  METHODS
  The study cohort included 176 patients (at least >12 months follow-up) with HBV cirrhosis/hepatocellular carcinoma who received secondary prophylaxis with indefinite entecavir/tenofovir after living-donor LT (LDLT). All patients received 10,000 IU intravenous HBIG in anhepatic phase followed by 600-1000 IU intramuscularly daily for 7 days, weekly for 3 weeks, and then monthly, to keep antiHBs levels >100 mIU/mL for 1 year. Hepatitis B surface antigen (HBsAg) and HBV DNA were tested every 6 months.
  
  
  RESULTS
  The study cohort is composed of 157 men and 19 women, mean age 47.9 ± 10.1 years, all HBsAg positive, 35 (19.8%) had HBV DNA >2000 IU/mL before LT. After LT, patients received entecavir (n = 126, 71.5%), tenofovir (n = 20, 11.3%), or a combination of entecavir and tenofovir (n = 30, 17% for 3 months), followed by entecavir alone. During follow-up of 43 (12-117) months, 2 patients (including 1 with non-compliance) had HBV recurrence.
  
  
  CONCLUSIONS
  In a large cohort of LDLT recipients for HBV-related liver disease, use of low-dose short-term HBIG with high genetic barrier drugs results in a substantially lower incidence of HBV recurrence, even in high-risk patients.
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: N S
authors: NS
authors: Choudhary
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: N
authors: N
authors: Saraf
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: S
authors: S
authors: Saigal
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: R
authors: R
authors: Mohanka
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: A
authors: A
authors: Rastogi
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: S
authors: S
authors: Goja
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: P B
authors: PB
authors: Menon
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors: A S
authors: AS
authors: Soin
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000517:prevention & control* / Q000821:virology; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006509:Hepatitis B / Q000517:prevention & control* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D019259:Lamivudine / Q000008:administration & dosage; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D000068698:Tenofovir / Q000008:administration & dosage
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000068698:Tenofovir; D000225:Adenine; C045213:hepatitis B hyperimmune globulin
keywords: HBIG; HBV DNA; HBsAg; entecavir; hepatitis B; liver transplantation; tenofovir