title: Rational Basis for Optimizing Short and Long-term Hepatitis B Virus Prophylaxis Post Liver Transplantation: Role of Hepatitis B Immune Globulin.
abstract: Antiviral therapy using newer nucleos(t)ide analogues with lower resistance rates, such as entecavir or tenofovir, suppress hepatitis B virus (HBV) replication, improve liver function in patients with compensated or decompensated cirrhosis, and delay or obviate the need for liver transplantation in some patients. After liver transplantation, the combination of long-term antiviral and low-dose hepatitis B Immune globulin (HBIG) can effectively prevent HBV recurrence in greater than 90% of transplant recipients. Some forms of HBV prophylaxis need to be continued indefinitely after transplantation but, in patients with a low-risk of HBV recurrence (i.e., HBV DNA levels undetectable before transplantation), it is possible to discontinue HBIG and maintain only long-term nucleos(t)ide analogue(s) therapy. A more cautious approach is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e., HIV or hepatitis D virus coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.
authors.affiliation: 1 AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France. 2 INSERM, U 1193, Villejuif, France. 3 Univ Paris-Sud, UMR-S 1193, Villejuif, France. 4 AP-HP Hôpital Paul Brousse, Laboratoire de Virologie, Villejuif, France. 5 Division of Liver and Biliopancreatic disorders, University Hospitals, KU, Leuven, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Roque-Afonso
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin