Oral Nucleoside/Nucleotide Analogs Without Hepatitis B... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

Liver

Oral Nucleoside/Nucleotide Analogs Without Hepatitis B Immune Globulin After Liver Transplantation for Hepatitis B

Fung, James MD1, 2, 3; Chan, See-Ching MS, PhD2, 3; Cheung, Cindy MPhil2; Yuen, Man-Fung MD, PhD1, 3; Chok, Kenneth Siu-Ho MBBS2; Sharr, William MBBS2; Chan, Albert Chi-Yan MBBS2; Cheung, Tan-To MBBS2; Seto, Wai-Kay MD1; Fan, Sheung-Tat MS, MD, PhD, DSc2, 3; Lai, Ching-Lung MD1, 3; Lo, Chung-Mau MS2, 3

1 Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China

2 Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China

3 State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China

Correspondence: Dr James Fung, MD, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China. E-mail: [email protected]

Received 3 October 2012; accepted 11 December 2012

published online 30 April 2013

Abstract

OBJECTIVES:

The long-term outcomes of oral antiviral therapy without hepatitis B immune globulin (HBIG) in prevention of reinfection with hepatitis B after liver transplantation are not known. We aimed to determine the long-term outcomes from a large population of chronic hepatitis B (CHB) liver transplant recipients using oral antiviral therapy alone.

METHODS:

A total of 362 consecutive CHB patients transplanted from January 2003 to May 2011 were included. None of the patients received HBIG. Viral serology, viral load, and liver biochemistry were performed at regular intervals during follow-up.

RESULTS:

Of the 362 patients, 176 (49%), 142 (39%), and 44 (12%) were on lamivudine (LAM), entecavir (ETV), and combination therapy (predominantly LAM+adefovir), respectively, at the time of transplant. The median follow-up length was 53 months. The rate of hepatitis B surface antigen seronegativity and hepatitis B virus (HBV) DNA suppression to undetectable levels at 8 years was 88 and 98%, respectively. The virological relapse rates (>1 log increase IU/ml) at 1, 3, 5, and 8 years was 5, 10, 13 and 16%, respectively. The virological relapse rate at 3 years for LAM, ETV, and combination group was 17, 0, and 7%, respectively ( P <0.001). Forty-two patients had virological relapse, of which 36 had YMDD mutation (31 in the LAM group and 5 in the combination group). The overall 8-year survival was 83%, with no difference between the three treatment groups ( P =0.94). No mortality from HBV recurrence occurred in the 362 patients.

CONCLUSIONS:

Oral nucleoside/nucleotide analogs without HBIG are effective in preventing graft loss secondary to hepatitis B recurrence after liver transplantation. However, new agents with a high barrier to resistance should be used to minimize drug resistance and to prevent virological rebound.