title: Prophylaxis Among Hepatitis B Core Antibody-positive Deceased-donor Liver Transplant Recipients: Hepatitis B Immunoglobulin Plus Oral Antiviral Agents Versus Antiviral Agents Alone: A Single-center Experience.
abstract: Hepatitis B core antibody immunoglobulin G seropositivity is evidence of past exposure to hepatitis B virus. Donor or recipient hepatitis B core antibody positivity may pose a risk of reactivation, especially early after liver transplant. Although most centers advocate using antiviral agents plus hepatitis B immunoglobulin, some have recently relied on antivirals only as prophylaxis after liver transplant. Here, we retrospectively investigated patient survival in hepatitis B core antibody-positive recipients, comparing those treated with antivirals plus hepatitis B immunoglobulin versus antivirals alone.
  
  
  
  After Internal Review Board approval, we reviewed medical records of deceased-donor liver transplant recipients between 1995 and 2013. Demographic characteristics, transplant indication, hepatitis B core antibody status, time to death, and type of posttransplant prophylaxis were recorded. We also recorded whether donors showed hepatitis B core antibody positivity. Patients who died within 30 days of liver transplant were excluded.
  
  
  
  There were 148 hepatitis B core antibody-positive recipients. Prophylaxis was given to 75 recipients after transplant: 8 (5%) received hepatitis B immunoglobulin, 22 (15%) received antivirals, and 45 (30%) received the combination. There were 34 deaths: 3 (38%) in hepatitis B immunoglobulin only, 3 (14%) in antiviral only, 8 (18%) in the combination, and 20 (27%) in no prophylaxis groups. One- and 5-year survival rates were similar for binary comparisons among prophylaxis groups (P > .05).
  
  
  
  Preliminary results support the current practice of using hepatitis B immunoglobulin plus antivirals for prophylaxis after liver transplant. The similar survival benefit with the combination versus antiviral agents alone suggests equal effectivity for prophylaxis posttransplant. However, a clear benefit of antivirals was not evident in our analysis. Future larger prospective studies are warranted to identify potential benefits of using antivirals alone as prophylaxis after liver transplant and to further clarify their role as the sole prophylactic regimen.
authors.affiliation: >From the Division of Gastroenterology and Hepatology, Transplant Hepatology, Johns Hopkins Hospital School of Medicine, Baltimore, Maryland, USA.
authors.forename: Mohammad U
authors.initials: MU
authors.lastname: Malik
authors.forename: Enver
authors.initials: E
authors.lastname: Ucbilek
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Trilianos
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Cameron
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gurakar
mesh_terms: D000284:Administration, Oral; D000906:Antibodies / Q000097:blood*; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015142:Baltimore; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D006515:Hepatitis B virus / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000906:Antibodies; D000998:Antiviral Agents; D006512:Hepatitis B Core Antigens; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin