title: Nucleos(t)ide analog(s) prophylaxis after hepatitis B immunoglobulin withdrawal against hepatitis B and D recurrence after liver transplantation.
abstract: OBJECTIVE
  Nucleos(t)ide analogs (NAs) have made a hepatitis B immunoglobulin (HBIG)-sparing protocol an attractive approach against hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, this approach is considered controversial in patients transplanted for HBV and hepatitis D (HDV) co-infection.
  
  
  METHODS
  All patients transplanted for HBV/HDV cirrhosis were evaluated. After LT, each patient received HBIG + NAs and then continued with NAs prophylaxis. All patients were followed up with HBV serum markers and HBV DNA, while anti-HDV/HDV RNA was performed in those with HBV recurrence.
  
  
  RESULTS
  A total of 34 recipients were included (22 men, age: 46.7 ± 16 years). After HBIG discontinuation, NAs were received as monoprophylaxis (lamivudine [LAM]: 2, adefovir [AFV]: 1, entecavir: 9, tenofovir [TDF]: 12) or dual prophylaxis (LAM + AFV [or TDF]: 10 patients). Two (5.8%) of the 34 patients had HBV/HDV recurrence after HBIG withdrawal (median follow-up: 28 [range, 12-58] months). These 2 patients had undetectable HBV DNA at LT. Statistical analysis revealed that those with recurrence had received HBIG for shorter period, compared to those without recurrence (median: 9 vs. 28 months, P = 0.008).
  
  
  CONCLUSIONS
  We showed for the first time, to our knowledge, that maintenance therapy with NAs prophylaxis after HBIG discontinuation was effective against HBV/HDV recurrence, but it seems that a longer period of HBIG administration might be needed before it is withdrawn after LT.
authors.affiliation: 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece. cholongitas@yahoo.gr.
authors.forename: E
authors.initials: E
authors.lastname: Cholongitas
authors.affiliation: 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Goulis
authors.affiliation: Department of Transplant Surgery, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Antoniadis
authors.affiliation: Department of Transplant Surgery, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Fouzas
authors.affiliation: Department of Transplant Surgery, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Imvrios
authors.affiliation: Department of Transplant Surgery, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Giakoustidis
authors.affiliation: Department of Transplant Surgery, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: O
authors.initials: O
authors.lastname: Giouleme
authors.affiliation: Department of Transplant Surgery, Medical School of Aristotle University, Thessaloniki, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Papanikolaou
authors.affiliation: 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Akriviadis
authors.affiliation: 3rd Department of Internal Medicine, Medical School of Aristotle University Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Vasiliadis
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D060085:Coinfection / Q000150:complications / Q000517:prevention & control*; D004279:DNA, Viral / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D005260:Female; D006147:Guanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000517:prevention & control*; D019701:Hepatitis D, Chronic / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use*; D019259:Lamivudine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D055502:Secondary Prevention / Q000379:methods*; D000068698:Tenofovir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000068698:Tenofovir; D000225:Adenine; C045213:hepatitis B hyperimmune globulin
keywords: entecavir; glomerular filtration rate; hepatitis B and D co-infection; hepatitis B recurrence; hepatitis D; liver transplantation; renal function; tenofovir