title: Antiviral Combination Therapy With Low-Dose Hepatitis B Immunoglobulin for the Prevention of Hepatitis B Virus Recurrence in Liver Transplant Recipients: A Single-Center Experience.
abstract: OBJECTIVE
  This study presents the overall long-term hepatitis B virus (HBV) recurrence rate with possible associated factors after hepatitis B immunoglobulin (HBIG) was given in combination with 4 different antiviral (lamivudine, adefovir, entecavir, and tenofovir) drugs.
  
  
  METHODS
  Between September 2000 and October 2013, the medical records of 42 adult patients who underwent liver transplantation at the Cukurova University Medical Hospital for chronic liver failure or hepatocellular carcinoma (HCC) secondary to chronic HBV were reviewed retrospectively. The analyses of risk factors for recurrence were performed based on the efficacy of hepatitis B envelope antigen (HBeAg), hepatitis B core antibody (anti-HBc), HBV DNA, preoperative prophylaxis, and the presence of HCC. Posttransplantation HBV recurrence was defined as persistence of hepatitis B surface antigen (HBsAg) positivity after orthotopic liver transplantation, or the reappearance of HBsAg and HBV DNA after initial HBsAg undetectability despite prophylaxis.
  
  
  RESULTS
  The mean follow-up of 28 patients having HBIG and lamivudine prophylaxis was 73.25 ± 37.5 months with a recurrence rate of 3.5%. The mean follow-up of 2 patients having HBIG and adefovir prophylaxis was 90 ± 46.6 months with a 50% recurrence rate. The mean follow-up of each 6 patients who received prophylaxis with entecavir and tenofovir groups were 27.5 ± 16.1 and 16.17 ± 5.3 respectively, with no posttransplantation recurrence for both groups. On univariate analysis, preoperative factors such as anti-HBc, HBV DNA, preoperative prophylaxis, and the presence of HCC did not show any correlation with recurrence. However, HBeAg showed statistical significance for recurrence.
  
  
  CONCLUSIONS
  Low-dose HBIG in combination with antiviral agents (lamivudine, entecavir, and tenofovir) is efficacious in preventing recurrence of HBV in posttransplantation patients.
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey. Electronic address: tlgakcam@yahoo.com.
authors.forename: A T
authors.initials: AT
authors.lastname: Akcam
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Ulku
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Rencuzogullari
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: I C
authors.initials: IC
authors.lastname: Eray
authors.affiliation: Department of General Surgery, Ankara University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Okoh
authors.affiliation: Department of Gastroenterology, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kuran
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Dalcı
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Yalav
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: C K
authors.initials: CK
authors.lastname: Parsak
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Sakman
authors.affiliation: Department of General Surgery, Cukurova University School of Medicine, Sarıcam, Adana, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Demiryurek
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D058625:End Stage Liver Disease / Q000209:etiology / Q000601:surgery*; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000008:administration & dosage*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin