title: Efficacy and safety of lamivudine or tenofovir plus intramuscular hepatitis B immunoglobulin in prevention of hepatitis B virus reinfection after liver transplant.
abstract: OBJECTIVE
  Hepatitis B immunoglobulin prophylaxis in combination with antiviral drugs is recommended for prevention of hepatitis B virus reinfection after liver transplant. However, there is no consensus on a standard prophylactic method, and controversy exists over the duration, dose, and route of administration. We conducted a prospective study to evaluate the safety and effectiveness of intramuscular hepatitis B immunoglobulin in combination with lamivudine and/or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year for prevention of hepatitis B virus reinfection.
  
  
  METHODS
  Patients with hepatitis Brelated liver cirrhosis who had undergone primary liver transplants were enrolled. The prophylactic protocol involved intraoperative intramuscular hepatitis B immunoglobulin at 10 000 IU, tapering to 5000 IU daily for the first 6 days, weekly for a month, every 2 weeks for the next month, and monthly for a year after liver transplant, in combination with antiviral drugs.
  
  
  RESULTS
  From January 2002 until March 2014, two hundred sixty-eight liver transplants were performed. Forty-four patients (16.4%) who underwent liver transplants due to hepatitis B-related liver failure were enrolled. Five patients had hepatocellular carcinoma; 20 had both hepatitis D and hepatitis B virus infection. The median age was 47 years (range, 26-59 y) with a median model for end stage liver disease score of 20. Thirty-three patients were men (76%). Sixty-one percent of patients were negative for hepatitis B virus DNA at the time of transplant. The median follow-up was 13.6 months (range, 0-142 mo). Only 1 patient (2.3%) experienced hepatitis B virus reinfection (at 44.7 months posttransplant), which was successfully treated with tenofovir. Five patients died (11.4%) during the follow-up from nonhepatitis B causes.
  
  
  CONCLUSIONS
  Intramuscular hepatitis B immunoglobulin in combination with lamivudine or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year posttransplant may provide safe and cost-effective protection against posttransplant hepatitis B reinfection.
authors.affiliation: From the Department of Gastroenterology-Hepatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohssen
authors.initials: M
authors.lastname: Nassiri-Toosi
authors.forename: Amir
authors.initials: A
authors.lastname: Kasraianfard
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ahmadinejad
authors.forename: Habibollah
authors.initials: H
authors.lastname: Dashti
authors.forename: Majıd
authors.initials: M
authors.lastname: Moini
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.forename: Javad
authors.initials: J
authors.lastname: Salimi
authors.forename: Ali
authors.initials: A
authors.lastname: Jafarian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000009:adverse effects; D007273:Injections, Intramuscular; D019259:Lamivudine / Q000008:administration & dosage* / Q000009:adverse effects; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D000068698:Tenofovir / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D019259:Lamivudine; D000068698:Tenofovir; C045213:hepatitis B hyperimmune globulin