Hepatitis B immunoglobulin and/or nucleos(t)ide analogues... : Liver Transplantation (original) (raw)

Original Articles

Hepatitis B immunoglobulin and/or nucleos(t)ide analogues for prophylaxis against hepatitis b virus recurrence after liver transplantation: A systematic review

Cholongitas, Evangelos1,*,†; Goulis, John1; Akriviadis, Evangelos1; Papatheodoridis, Geore V.2

1_Fourth Department of Internal Medicine, Aristotle University Medical School, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece_

2_Second Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Athens, Greece_

*Address reprint requests to Senior Lecturer of Internal Medicine, Fourth Department of Internal Medicine, Aristotle University Medical School, Hippokration General Hospital of Thessaloniki, 49 Konstantinopoleos Street, 54642, Thessaloniki, Greece

Email: [email protected]

Received 10 April 2011; Accepted 27 May 2011

†Telephone: +30-2310992814; FAX: +30-2310999942

Abstract

A combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues (NUCs) is currently recommended as prophylaxis against the recurrence of hepatitis B virus (HBV) after liver transplantation (LT), but the optimal protocol is a matter of controversy. The aim of this study was the identification of factors associated with post-LT HBV recurrence in patients receiving HBIG and NUCs. We searched MEDLINE and PubMed for studies in English about the effectiveness of HBIG and NUCs [lamivudine (LAM) and/or adefovir dipivoxil (ADV)] against post-LT HBV recurrence (January 1998 to June 2010). Forty-six studies, which included 2162 HBV LT recipients, met the selection criteria. Patients receiving HBIG and LAM experienced HBV recurrence more frequently than patients receiving HBIG and ADV with or without LAM [6.1% (115/1889) versus 2.0% (3/152), P = 0.024], although they also were more frequently treated with indefinite HBIG prophylaxis (90% versus 57%, P < 0.001). For patients receiving HBIG and LAM, a lower frequency of HBV recurrence was associated with a high HBIG dosage (≥10,000 IU/day) versus a low HBIG dosage (<10,000 IU/day) during the first week after LT [3.2% (14/440) versus 6.5% (80/1233), P = 0.016], but the HBIG protocol had no impact on HBV recurrence in patients receiving HBIG and ADV. In conclusion, in comparison with the combination of HBIG and LAM, the combination of HBIG and ADV is associated with a lower rate of HBV recurrence after LT. Patients receiving HBIG and LAM should be given a high dosage of HBIG during the first week after LT, but a lower dosage can be used safely in patients receiving HBIG and ADV. Further studies with newer and more potent anti-HBV agents are definitely required. Liver Transpl 17:1176–1190, 2011. © 2011 AASLD.

Abbreviations: ADV, adefovir dipivoxil; anti-HBs, antibody to hepatitis B surface antigen; bDNA, branched DNA; HBeAg, hepatitis B e antigen; HBIG, hepatitis B immunoglobulin; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; IM, intramuscular(ly); IV, intravenous(ly); LAM, lamivudine; LT, liver transplantation; NA, not available; NUC, nucleos(t)ide analogue; PC, prospective cohort study; PCR, polymerase chain reaction; RC, retrospective cohort study; RCT, randomized controlled trial; TMA, transcription-mediated amplification.