Long-term efficacy of nucleoside monotherapy in preventing HBV infection in HBsAg-negative recipients of anti-HBc-positive donor livers - PubMed (original) (raw)

Long-term efficacy of nucleoside monotherapy in preventing HBV infection in HBsAg-negative recipients of anti-HBc-positive donor livers

Watcharasak Chotiyaputta et al. Hepatol Int. 2010.

Abstract

Background and aim: Transmission of hepatitis B virus (HBV) infection occurs in up to 87.5% of HBsAg-negative recipients of anti-HBc-positive donor livers in the absence of HBV prophylaxis. There is no standardized prophylactic regimen to prevent HBV infection in this setting. The aim of this study was to determine the long-term efficacy of nucleoside analogue to prevent HBV infection in this setting.

Methods: A retrospective study of HBsAg-negative patients receiving liver transplantation (LT) from anti-HBc-positive donors during a 10-year period.

Results: Twenty patients were studied, mean age was 50.2 ± 8.3 years, 40% were men, and 90% were Caucasian. The median MELD score at the time of LT was 18 (12-40). None of the patients received hepatitis B immune globulin. Eighteen patients received nucleoside analogue monotherapy: 10 received lamivudine and 8 received entecavir. None of these 18 patients developed HBV infection after a median follow up of 32 (1-75) months. One patient received a second course of hepatitis B vaccine 50 months after LT with anti-HBs titer above 1,000 mIU/mL. Lamivudine was discontinued and the patient remained HBsAg negative 18 months after withdrawal of lamivudine. Two patients who were anti-HBs positive before LT were not started on HBV prophylaxis after LT; both developed HBV infection after LT.

Conclusions: Nucleoside monotherapy is sufficient in preventing HBV infection in HBsAg-negative recipients of anti-HBc-positive donor livers. HBV prophylaxis is necessary in anti-HBs-positive recipients of anti-HBc-positive donor livers.

Keywords: Entecavir; HBV infection; HBV vaccine; Hepatitis B immune globulin; Lamivudine.

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Figures

Fig. 1

Fig. 1

Patient A: 45-year-old Caucasian female received three doses of HBV vaccine with anti-HBs response pre-LT. Post-LT, patient received lamivudine monotherapy. At month 50 post-LT, she received a second course of HBV vaccine. Lamivudine was withdrawn at month 57 when her anti-HBs titer was >1,000 mIU/mL. She remained HBsAg negative with undetectable HBV DNA 18 months after lamivudine withdrawal. However, anti-HBs titer had dropped to 83 mIU/mL 16 months after completion of the second course of HBV vaccine. One double dose of HBV DNA vaccine was administered and anti-HBs titer retested 1 month later increased to more than 1,000 mIU/mL. HBV hepatitis B virus, LT liver transplantation, HBsAg hepatitis B surface antigen, Anti-HBs hepatitis B surface antibody, Anti-HBc hepatitis B core antibody, HBeAg hepatitis B e antigen, Anti-HBe hepatitis B e antibody, ALT alanine aminotransferase; UD, undetectable

Fig. 2

Fig. 2

Patient B: 27-year-old Caucasian female received two doses of HBV vaccine with anti-HBs response before LT. Post-LT, she did not receive any HBV prophylaxis. HBV infection was diagnosed 15 months post-LT. Patient was asymptomatic and had mildly elevated ALT. Entecavir was started and HBV DNA decreased from 8.9 log10 IU/mL to <100 IU/mL within 10 months. HBV hepatitis B virus, LT liver transplantation, HBsAg hepatitis B surface antigen, Anti-HBs hepatitis B surface antibody, Anti-HBc hepatitis B core antibody, HBeAg hepatitis B e antigen, Anti-HBe hepatitis B e antibody, ALT alanine aminotransferase, UD undetectable

Fig. 3

Fig. 3

Patient C: 61-year-old Caucasian female received three doses of HBV vaccine and was anti-HBs positive and anti-HBc negative before LT. She did not receive any HBV prophylaxis regimen after LT. At 12 months post-LT, she was found to be HBsAg negative with undetectable HBV DNA, but anti-HBc positive. Entecavir was started and patient remained HBsAg negative with undetectable HBV DNA. HBV hepatitis B virus, LT liver transplantation, HBsAg hepatitis B surface antigen, Anti-HBs hepatitis B surface antibody, Anti-HBc hepatitis B core antibody, HBeAg hepatitis B e antigen, Anti-HBe hepatitis B e antibody, UD undetectable

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