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

TY - JOUR

T1 - Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients

T2 - A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal

AU - Manini, Matteo A.

AU - Whitehouse, Gavin

AU - Bruce, Matthew

AU - Passerini, Matteo

AU - Lim, Tiong Y.

AU - Carey, Ivana

AU - Considine, Aisling

AU - Lampertico, Pietro

AU - Suddle, Abid

AU - Heaton, Nigel

AU - Heneghan, Michael

AU - Agarwal, Kosh

PY - 2018/4/13

Y1 - 2018/4/13

N2 - 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.

AB - 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.

KW - Hepatocellular carcinoma

KW - HBsAg titre

KW - HBV DNA level

KW - antiviral drug-resistance mutation

KW - safety

U2 - 10.1016/j.dld.2018.03.032

DO - 10.1016/j.dld.2018.03.032

M3 - Article

SN - 1590-8658

JO - DIGESTIVE AND LIVER DISEASE

JF - DIGESTIVE AND LIVER DISEASE

ER -