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 21 November 2017

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News

Prophylaxis against recurrence of Hep B after liver transplant

The most recent issue of Liver International investigates prophylaxsis against recurrence of Hep B virus after liver transplantation.

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Liver transplantation in patients with Hepatitis B virus infection is associated with a high rate of graft loss and poor survival, unless re-infection can be prevented.

Human Hepatitis B immune globulin has long been utilized to prevent re-infection.

Dr Nevin Yilmaz and colleagues from Virginia, USA found that more recently, an anti-viral agent has been utilized along with human Hepatitis B immune globulin.

However, the regimens utilized have varied considerably among liver transplantation programs, and the optimal regimen has never been defined.

Recurrence can be prevented in E-antigen-negative patients with human Hep B immune globulin alone
Liver International

The team conducted a retrospective analysis of 41 patients who underwent liver transplantation for Hepatitis B virus at their center since 1985.

The patients received either human Hepatitis B immune globulin with or without an anti-viral agent.

The mean age of these patients was 46 years, of which 81% were male.

The mean and maximal follow-up were 6 and 15 years, respectively.

The team found that 8 out of 15 E-antigen-positive patients who received human Hepatitis B immune globulin alone developed recurrence after a mean of 17 months.

In contrast, none of 10 E-antigen-negative patients who received human Hepatitis B immune globulin alone developed recurrence.

None of the 10 E-antigen-positive patients who received both human Hepatitis B immune globulin, and either lamivudine or adefovir developed recurrence.

The team of doctors found that as long as the anti-Hepatitis B surface remained detectable, no absolute minimum serum level appeared to lead to recurrent Hepatitis B virus.

Dr Yilmaz's team concluded, "Recurrence of Hepatitis B virus following liver transplantation can be prevented in E-antigen-positive patients with a combination of human Hepatitis B immune globulin, and an anti-viral agent."

"In contrast, recurrence can be prevented in E-antigen-negative patients with human Hepatitis B immune globulin alone."

"Maintaining a serum anti-Hepatitis B surface level above a minimum arbitrary titre of 200 pg/mL did not appear to be necessary for effective human Hepatitis B immune globulin prophylaxis."

Liver Int 2008: 28(1): 72-8
22 January 2008

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