TY - JOUR
T1 - Prophylaxis among hepatitis B core antibody-positive deceased-donor liver transplant recipients
T2 - Hepatitis b immunoglobulin plus oral antiviral agents versus antiviral agents alone: A single-center experience
AU - Malik, Mohammad U.
AU - Ucbilek, Enver
AU - Trilianos, Panagiotis
AU - Cameron, Andrew M.
AU - Gurakar, Ahmet
N1 - Publisher Copyright:
© Başkent University 2017 Printed in Turkey. All Rights Reserved.
PY - 2017/4
Y1 - 2017/4
N2 - Objectives: Hepatitis B core antibody immunoglobulin G seropositivity is evidence of past exposure to hepatitis B virus. Donor or recipient hepatitis B core antibody positivity may pose a risk of reactivation, especially early after liver transplant. Although most centers advocate using antiviral agents plus hepatitis B immunoglobulin, some have recently relied on antivirals only as prophylaxis after liver transplant. Here, we retrospectively investigated patient survival in hepatitis B core antibody-positive recipients, comparing those treated with antivirals plus hepatitis B immunoglobulin versus antivirals alone. Materials and Methods: After Internal Review Board approval, we reviewed medical records of deceaseddonor liver transplant recipients between 1995 and 2013. Demographic characteristics, transplant indication, hepatitis B core antibody status, time to death, and type of posttransplant prophylaxis were recorded. We also recorded whether donors showed hepatitis B core antibody positivity. Patients who died within 30 days of liver transplant were excluded. Results: There were 148 hepatitis B core antibodypositive recipients. Prophylaxis was given to 75 recipients after transplant: 8 (5%) received hepatitis B immunoglobulin, 22 (15%) received antivirals, and 45 (30%) received the combination. There were 34 deaths: 3 (38%) in hepatitis B immunoglobulin only, 3 (14%) in antiviral only, 8 (18%) in the combination, and 20 (27%) in no prophylaxis groups. One- and 5-year survival rates were similar for binary comparisons among prophylaxis groups (P >.05). Conclusions: Preliminary results support the current practice of using hepatitis B immunoglobulin plus antivirals for prophylaxis after liver transplant. The similar survival benefit with the combination versus antiviral agents alone suggests equal effectivity for prophylaxis posttransplant. However, a clear benefit of antivirals was not evident in our analysis. Future larger prospective studies are warranted to identify potential benefits of using antivirals alone as prophylaxis after liver transplant and to further clarify their role as the sole prophylactic regimen.
AB - Objectives: Hepatitis B core antibody immunoglobulin G seropositivity is evidence of past exposure to hepatitis B virus. Donor or recipient hepatitis B core antibody positivity may pose a risk of reactivation, especially early after liver transplant. Although most centers advocate using antiviral agents plus hepatitis B immunoglobulin, some have recently relied on antivirals only as prophylaxis after liver transplant. Here, we retrospectively investigated patient survival in hepatitis B core antibody-positive recipients, comparing those treated with antivirals plus hepatitis B immunoglobulin versus antivirals alone. Materials and Methods: After Internal Review Board approval, we reviewed medical records of deceaseddonor liver transplant recipients between 1995 and 2013. Demographic characteristics, transplant indication, hepatitis B core antibody status, time to death, and type of posttransplant prophylaxis were recorded. We also recorded whether donors showed hepatitis B core antibody positivity. Patients who died within 30 days of liver transplant were excluded. Results: There were 148 hepatitis B core antibodypositive recipients. Prophylaxis was given to 75 recipients after transplant: 8 (5%) received hepatitis B immunoglobulin, 22 (15%) received antivirals, and 45 (30%) received the combination. There were 34 deaths: 3 (38%) in hepatitis B immunoglobulin only, 3 (14%) in antiviral only, 8 (18%) in the combination, and 20 (27%) in no prophylaxis groups. One- and 5-year survival rates were similar for binary comparisons among prophylaxis groups (P >.05). Conclusions: Preliminary results support the current practice of using hepatitis B immunoglobulin plus antivirals for prophylaxis after liver transplant. The similar survival benefit with the combination versus antiviral agents alone suggests equal effectivity for prophylaxis posttransplant. However, a clear benefit of antivirals was not evident in our analysis. Future larger prospective studies are warranted to identify potential benefits of using antivirals alone as prophylaxis after liver transplant and to further clarify their role as the sole prophylactic regimen.
KW - HBIG
KW - Hepatitis B
KW - Liver transplant
KW - Oral antivirals
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UR - http://www.scopus.com/inward/citedby.url?scp=85019200374&partnerID=8YFLogxK
U2 - 10.6002/ect.2015.0277
DO - 10.6002/ect.2015.0277
M3 - Article
C2 - 27212251
AN - SCOPUS:85019200374
SN - 1304-0855
VL - 15
SP - 183
EP - 188
JO - Experimental and Clinical Transplantation
JF - Experimental and Clinical Transplantation
IS - 2
ER -