Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients: A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal

Matteo A. Manini, Gavin Whitehouse, Matthew Bruce, Matteo Passerini, Tiong Y. Lim, Ivana Carey, Aisling Considine, Pietro Lampertico, Abid Suddle, Nigel Heaton, Michael Heneghan, Kosh Agarwal

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Abstract

BackgroundRecent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT).
Patients and Methods Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. 
Results Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Group A and B patients were followed for 69 (range 13-83) months and 61 (range 31-78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1-40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. 
Conclusion HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.
Original languageEnglish
JournalDIGESTIVE AND LIVER DISEASE
Early online date13 Apr 2018
DOIs
Publication statusE-pub ahead of print - 13 Apr 2018

Keywords

  • Hepatocellular carcinoma
  • HBsAg titre
  • HBV DNA level
  • antiviral drug-resistance mutation
  • safety

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