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Rational Basis for Optimizing Short and Long-term Hepatitis B Virus Prophylaxis Post Liver Transplantation: Role of Hepatitis B Immune Globulin.

Roche B, Roque-Afonso AM, Nevens F, Samuel D - Transplantation (2015)

Bottom Line: After liver transplantation, the combination of long-term antiviral and low-dose hepatitis B Immune globulin (HBIG) can effectively prevent HBV recurrence in greater than 90% of transplant recipients.A more cautious approach is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e., HIV or hepatitis D virus coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy.In this group, HBIG-free prophylaxis cannot be recommended.

View Article: PubMed Central - PubMed

Affiliation: 1 AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France. 2 INSERM, U 1193, Villejuif, France. 3 Univ Paris-Sud, UMR-S 1193, Villejuif, France. 4 AP-HP Hôpital Paul Brousse, Laboratoire de Virologie, Villejuif, France. 5 Division of Liver and Biliopancreatic disorders, University Hospitals, KU, Leuven, Belgium.

ABSTRACT
Antiviral therapy using newer nucleos(t)ide analogues with lower resistance rates, such as entecavir or tenofovir, suppress hepatitis B virus (HBV) replication, improve liver function in patients with compensated or decompensated cirrhosis, and delay or obviate the need for liver transplantation in some patients. After liver transplantation, the combination of long-term antiviral and low-dose hepatitis B Immune globulin (HBIG) can effectively prevent HBV recurrence in greater than 90% of transplant recipients. Some forms of HBV prophylaxis need to be continued indefinitely after transplantation but, in patients with a low-risk of HBV recurrence (i.e., HBV DNA levels undetectable before transplantation), it is possible to discontinue HBIG and maintain only long-term nucleos(t)ide analogue(s) therapy. A more cautious approach is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e., HIV or hepatitis D virus coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.

No MeSH data available.


Related in: MedlinePlus

Prophylaxis for prevention of HBV graft recurrence after LT. Proposal for guideline.
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Figure 1: Prophylaxis for prevention of HBV graft recurrence after LT. Proposal for guideline.

Mentions: Viral suppression is the goal for all patients on a waiting list. For patients without detectable viral replication before transplantation, there is no evidence that preoperative antiviral therapy is useful. For patients with viral replication before transplantation, ETV, TDV or a nucleoside/nucleotide combination should be used. There is a consensus regarding the need for a lifelong prophylactic therapy supported by the detection of HBV DNA in both hepatic and extrahepatic sites in patients who are HBsAg negative on posttransplant HBIG and antivirals. In the early posttransplant period, some studies reported that a high IV HBIG dose (≥10,000 IU/day) versus a low HBIG dose (<10,000 IU/day) was associated with a lower frequency of HBV recurrence. At long-term, low-dose IM or subcutaneous HBIG in combination with a potent nucleos(t)ide analogue is the most cost-effective prophylaxis. Patients with an undetectable HBV DNA level at the time of transplant are eligible for protocols using short-term low dose IV or IM HBIG and antiviral therapy, followed by antiviral monotherapy (Figure 1). A more cautious approach to this prophylactic regimen is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurred (i.e., HIV or HDV coinfection, preexisting drug resistance or intolerance), those with a high risk of HCC recurrence and those with a risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.


Rational Basis for Optimizing Short and Long-term Hepatitis B Virus Prophylaxis Post Liver Transplantation: Role of Hepatitis B Immune Globulin.

Roche B, Roque-Afonso AM, Nevens F, Samuel D - Transplantation (2015)

Prophylaxis for prevention of HBV graft recurrence after LT. Proposal for guideline.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539198&req=5

Figure 1: Prophylaxis for prevention of HBV graft recurrence after LT. Proposal for guideline.
Mentions: Viral suppression is the goal for all patients on a waiting list. For patients without detectable viral replication before transplantation, there is no evidence that preoperative antiviral therapy is useful. For patients with viral replication before transplantation, ETV, TDV or a nucleoside/nucleotide combination should be used. There is a consensus regarding the need for a lifelong prophylactic therapy supported by the detection of HBV DNA in both hepatic and extrahepatic sites in patients who are HBsAg negative on posttransplant HBIG and antivirals. In the early posttransplant period, some studies reported that a high IV HBIG dose (≥10,000 IU/day) versus a low HBIG dose (<10,000 IU/day) was associated with a lower frequency of HBV recurrence. At long-term, low-dose IM or subcutaneous HBIG in combination with a potent nucleos(t)ide analogue is the most cost-effective prophylaxis. Patients with an undetectable HBV DNA level at the time of transplant are eligible for protocols using short-term low dose IV or IM HBIG and antiviral therapy, followed by antiviral monotherapy (Figure 1). A more cautious approach to this prophylactic regimen is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurred (i.e., HIV or HDV coinfection, preexisting drug resistance or intolerance), those with a high risk of HCC recurrence and those with a risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.

Bottom Line: After liver transplantation, the combination of long-term antiviral and low-dose hepatitis B Immune globulin (HBIG) can effectively prevent HBV recurrence in greater than 90% of transplant recipients.A more cautious approach is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e., HIV or hepatitis D virus coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy.In this group, HBIG-free prophylaxis cannot be recommended.

View Article: PubMed Central - PubMed

Affiliation: 1 AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France. 2 INSERM, U 1193, Villejuif, France. 3 Univ Paris-Sud, UMR-S 1193, Villejuif, France. 4 AP-HP Hôpital Paul Brousse, Laboratoire de Virologie, Villejuif, France. 5 Division of Liver and Biliopancreatic disorders, University Hospitals, KU, Leuven, Belgium.

ABSTRACT
Antiviral therapy using newer nucleos(t)ide analogues with lower resistance rates, such as entecavir or tenofovir, suppress hepatitis B virus (HBV) replication, improve liver function in patients with compensated or decompensated cirrhosis, and delay or obviate the need for liver transplantation in some patients. After liver transplantation, the combination of long-term antiviral and low-dose hepatitis B Immune globulin (HBIG) can effectively prevent HBV recurrence in greater than 90% of transplant recipients. Some forms of HBV prophylaxis need to be continued indefinitely after transplantation but, in patients with a low-risk of HBV recurrence (i.e., HBV DNA levels undetectable before transplantation), it is possible to discontinue HBIG and maintain only long-term nucleos(t)ide analogue(s) therapy. A more cautious approach is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e., HIV or hepatitis D virus coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.

No MeSH data available.


Related in: MedlinePlus