Low-dose short-term hepatitis B immunoglobulin with high genetic barrier antivirals: the ideal post-transplant hepatitis B virus prophylaxis?

BackgroundLow-dose hepatitis B immunoglobulin (HBIG) and nucleos(t)ides analogs (lamivudine/adefovir) used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT) are associated with some risk of HBV recurrence and antiviral resistance. MethodsThe study cohort included 176 patients (at least >12months follow-up) with HBV cirrhosis/hepatocellular carcinoma who received secondary prophylaxis with indefinite entecavir/tenofovir after living-donor LT (LDLT). All patients received 10,000IU intravenous HBIG in anhepatic phase followed by 600-1000IU intramuscularly daily for 7days, weekly for 3weeks, and then monthly, to keep antiHBs levels >100mIU/mL for 1year. Hepatitis B surface antigen (HBsAg) and HBV DNA were tested every 6 months. ResultsThe study cohort is composed of 157 men and 19 women, mean age 47.910.1years, all HBsAg positive, 35 (19.8%) had HBV DNA >2000IU/mL before LT. After LT, patients received entecavir (n=126, 71.5%), tenofovir (n=20, 11.3%), or a combination of entecavir and tenofovir (n=30, 17% for 3months), followed by entecavir alone. During follow-up of 43 (12-117) months, 2 patients (including 1 with non-compliance) had HBV recurrence. ConclusionIn a large cohort of LDLT recipients for HBV-related liver disease, use of low-dose short-term HBIG with high genetic barrier drugs results in a substantially lower incidence of HBV recurrence, even in high-risk patients.