title: Efficacy and effectiveness of anti-HBV therapy with early withdrawal of HBIG prophylaxis to prevent HBV recurrence following liver transplantation.
abstract: BACKGROUND
  The traditional regimen for prophylaxis of hepatitis B recurrence post-liver transplantation is to use hepatitis B immune globulin (HBIG) along with oral antiviral therapy; however, it is unclear when it is safe to discontinue HBIG after certain time point and to maintain patients with only oral antiviral therapy. Several studies have suggested that maintenance with oral anti-hepatitis B virus (HBV) therapy following short-term or no HBIG following the immediate post-transplantation period may also be safe and effective in prevention of HBV recurrence.
  
  
  METHODS
  We reviewed relevant literature to determine the effectiveness of early withdrawal of HBIG after liver transplantation and its effect on prevention of HBV recurrence. We used PubMed to search for any studies that used HBIG-free or short-term HBIG protocols with continued anti-HBV therapy. Short-term is defined as 12 months or less, and it is an evolving concept as new data on shorter and shorter duration becomes available. Additionally, a mini-quantitative analysis of the studies was performed using studies that involved the use of entecavir and tenofovir as anti-HBV therapy with or without HBIG.
  
  
  CONCLUSIONS
  Patients who are considered low risk for HBV recurrence at the time of liver transplant may safely be able to utilize a short-term duration of HBIG with indefinite antiviral maintenance therapy afterwards, whereas high-risk patients will likely need long-term HBIG in combination with antiviral therapy.
authors: Stanford University Medical Center, Division of Gastroenterology and Hepatology , 750 Welch Rd, Suite #210, Palo Alto, CA 94304 , USA.
authors: Winston
authors: W
authors: Ku
authors: Uerica
authors: U
authors: Wang
authors: Mindie H
authors: MH
authors: Nguyen
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000188:drug therapy* / Q000601:surgery*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007116:Immunization, Passive / Q000639:trends; D007136:Immunoglobulins / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000639:trends; D056990:Post-Exposure Prophylaxis / Q000639:trends; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin
keywords: antiviral therapy; hepatitis B immunoglobulin; hepatitis B recurrence; hepatitis B virus; liver transplantation; prophylaxis