Impact of Virologic Breakthrough and HBIG Regimen on Hepatitis B

liver411

<http://www3.interscience.wiley.c ... ETRY=1&SRETRY=0>

American Journal of Transplantation
Volume 10 Issue 8, Pages 1823 - 1833
Published Online: 23 Mar 2010
© 2010 American Society of Transplantation and the American Society of
Transplant Surgeons

Impact of Virologic Breakthrough and HBIG Regimen on Hepatitis B Recurrence
After Liver Transplantation

B. Degertekin a , Steven-Huy B. Han b , E. B. Keeffe c , E. R. Schiff d , V.
A. Luketic e , R. S. Brown, Jr. f , S. Emre g , C. Soldevila-Pico h , K. R.
Reddy i , M. B. Ishitani j , T. T. Tran k , T. L. Pruett l , A. S. F. Lok m,*,
and the NIH HBV-OLT Study Group

a Division of Gastroenterology, University of Michigan Health System, Ann
Arbor, MI   b University of California, Los Angeles, CA   c Division of
Gastroenterology and Hepatology, Stanford University Medical Center, Stanford,
CA   d University of Miami, Miami, FL   e Virginia Commonwealth University,
Richmond, VA   f Columbia Presbyterian Medical Center, New York, NY   g Yale
University School of Medicine, New Haven, CT   h University of Florida,
Gainesville, FL   i University of Pennsylvania, Philadelphia, PA   j Mayo
Clinic, Rochester, MN   k Cedars Sinai Medical Center, Los Angeles, CA   l
University of Virginia, Charlottesville, VA   m Division of Gastroenterology,
University of Michigan Health System, Ann Arbor, MI

* Corresponding author: Anna S. F. Lok, [email protected]

Copyright © 2010 American Society of Transplantation and the American Society
of Transplant Surgeons

ABSTRACT

The availability of hepatitis B immune globulin (HBIG) and several oral
antiviral therapies has reduced but not eliminated hepatitis B virus (HBV)
recurrence. We aimed to determine the rate of HBV recurrence after orthotopic
liver transplantation (OLT) in relation to virologic breakthrough pre-OLT and
HBIG regimens post-OLT. Data from the NIH HBV-OLT database were analyzed. A
total of 183 patients transplanted between 2001 and 2007 followed for a median
of 42 months (range 1–81) post-OLT were studied. At transplant, 29% were
hepatitis B e antigen (HBeAg) (+), 38.5% had HBV DNA> 5 log10 copies/mL, 74%
were receiving antiviral therapy. Twenty-five patients experienced virologic
breakthrough before OLT. Post-OLT, 26%, 22%, 40% and 12% of patients received
intravenous (IV) high-dose, IV low-dose, intramuscular low-dose and a finite
duration of HBIG, respectively as maintenance prophylaxis. All but two
patients also received antiviral therapy. Cumulative rates of HBV recurrence
at 1 and 5 years were 3% and 9%, respectively. Multivariate analysis showed
that listing HBeAg status and HBV DNA level at OLT were the only factors
associated with HBV recurrence. In conclusion, low rates of HBV recurrence can
be accomplished with all the HBIG regimens used when combined with antiviral
therapy including patients with breakthrough pre-OLT as long as rescue therapy
is administered pre- and post-OLT.

-------------------------------------------------------------------------------
-
Received 07 October 2009, revised 30 November 2009 and accepted for
publication 21 December 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1600-6143.2010.03046