Hepatitis B immunoglobulin and/or nucleos(t)ide analogue(s) for prophylaxis from hepatitis B virus recurrence after liver transplantation: A systematic review

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http://onlinelibrary.wiley.com/doi/10.1002/lt.22354/abstract

Original Article

Hepatitis B immunoglobulin and/or nucleos(t)ide analogue(s) for prophylaxis from

hepatitis B virus recurrence after liver transplantation: A systematic review

Evangelos Cholongitas1,*,†, Goulis1, Evangelos Akriviadis1, Geore V.

Papatheodoridis2

DOI: 10.1002/lt.22354

Copyright © 2011 American Association for the Study of Liver Diseases

Issue

Liver Transplantation

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background/Aim:

The combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues

[NUC(s)] is currently recommended for prophylaxis against HBV recurrence after

liver transplantation (LT), but the optimal protocol is controversial. The aim

was to identify the factors associated with post-LT HBV recurrence in patients

receiving HBIG and NUC(s).

Methods:

Studies published in English in Medline/PubMed from 1998 to June 2010 reporting

the effectiveness of HBIG and NUC(s) [lamivudine and/or adefovir] against

post-LT HBV recurrence.

Results:

Forty-six studies including 2162 HBV liver transplant recipients met the

selection criteria. Patients under HBIG and lamivudine compared to those under

HBIG and adefovir (with or without lamivudine) had more frequently on therapy

HBV recurrence [115/1889 (6%) vs 3/152 (2%), p=0.024), although they received

more frequently indefinite HBIG prophylaxis (90% vs 57%, p<0.001). In patients

under HBIG and lamivudine, high (≥10,000 IU/day) compared to low HBIG dose

during the 1st-week post-LT was associated with less frequent HBV recurrences

[14/440 (3.3%) vs 80/1233 (6.5%), p=0.016], while the HBIG protocol had no

impact on HBV recurrence in patients under HBIG and adefovir.

Conclusions:

The combination of HBIG/adefovir is associated with a lower rate of HBV

recurrence than HBIG/lamivudine after LT. In patients receiving HBIG/lamivudine,

HBIG should be given at high dosage during the 1st-week post-LT, while lower

HBIG dosage can be safely used in patients receiving HBIG/adefovir. Further

studies with the newer, more potent anti-HBV agents, are definitely required.

Liver Transpl, 2011. © 2011 AASLD.