Hepatol Int. 2020 Jan 10. doi: 10.1007/s12072-019-10011-2. [Epub ahead of print]
Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious.
Muthiah MD1,2,3, Tan EY4, Chua SHM4, Huang DQY1,2,3, Bonney GK2,5, Kow AWC2,5, Lim SG1,2,3, Dan YY1,2,3, Tan PS1,2,3, Lee GH6,7,8, Lim BL1,2.
Author information
1
Department of Gastroenterology and Hepatology, National University Health System, 5 Lower Kent Ridge Road, Main Building Level 1, Singapore, 119074, Singapore.
2
National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.
3
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
4
University Medicine Cluster, National University Health System, Singapore, Singapore.
5
Department of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore, Singapore.
6
Department of Gastroenterology and Hepatology, National University Health System, 5 Lower Kent Ridge Road, Main Building Level 1, Singapore, 119074, Singapore. [email protected].
7
National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore. [email protected].
8
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. [email protected].
Abstract
BACKGROUND:
Combination therapy with HBIG and NAs has reduced HBV recurrence post LT. Despite its efficacy, costs of HBIG remain prohibitive. With high-potency NAs, HBIG's use has been questioned. We aim to evaluate the efficacy and safety of HBIG-free regimens in patients transplanted for HBV-related liver disease.
METHODS:
A review of LT patients at the National University Hospital, Singapore from 2001 to 2015 was performed. Patients transplanted for HBV were divided by antiviral treatment received: high- or low-potency NAs, or a combination of HBIG with high-potency NAs. Post-transplant outcomes were reviewed till data censure. Primary outcome was recurrence of HBV viremia post-transplant, while secondary outcomes were HBsAg sero-clearance, graft survival and mortality.
RESULTS:
Among 58 patients, 51 (88%) had persistent HBV viral suppression. Patients on a high-potency agent had significantly higher viral suppression compared to those on a low-potency agent (97% vs 72%, p = 0.02). This was also seen in patients with VL detectable at transplant (100% vs 50%, p < 0.01). None of the 16 patients with VL detectable at transplant and treated with high-potency agents developed recurrence. 42 patients (72%) achieved persistent HBsAg sero-clearance. Although this was higher in the high-potency NA-only group, it was not statistically significant (p = 0.56). There were no graft failures or mortalities attributed to HBV recurrence.
CONCLUSION:
With the use of high-potency agents, HBIG may not be necessary in the treatment of patients transplanted for HBV-related liver disease, even in the presence of detectable VL at time of transplant.
KEYWORDS: