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Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious
Authors
Authors and affiliations
Mark D. MuthiahEn Ying TanSin Hui Melissa ChuaDaniel Q. Y. HuangGlenn K. BonneyAlfred W. C. KowSeng Gee LimYock Young DanPoh Seng TanGuan Huei LeeEmail authorBoon Leng Lim
Mark D. Muthiah
123
En Ying Tan
4
Sin Hui Melissa Chua
4
Daniel Q. Y. Huang
123
Glenn K. Bonney
25
Alfred W. C. Kow
25
Seng Gee Lim
123
Yock Young Dan
123
Poh Seng Tan
123
Guan Huei Lee
123Email authorView author's OrcID profile
Boon Leng Lim
12
1.Department of Gastroenterology and HepatologyNational University Health SystemSingaporeSingapore
2.National University Centre for Organ TransplantationNational University Health SystemSingaporeSingapore
3.Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
4.University Medicine Cluster, National University Health SystemSingaporeSingapore
5.Department of Hepatobiliary and Pancreatic SurgeryNational University Health SystemSingaporeSingapore
Original Article
First Online: 10 January 2020
69 Downloads
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
HBIG Hepatitis B Liver transplant Nucleoside analogs Low potency High potency Lamivudine Tenofovir Entecavir Asian |
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发表于 2020-2-5 16:04