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- Title
Prevention and risk factors of hepatitis B recurrence after living donor liver transplantation.
- Authors
Na, Gun Hyung; Kim, Dong Goo; Han, Jae Hyun; Kim, Eun Young; Lee, Soo Ho; Hong, Tae Ho; You, Young Kyoung; Choi, Jong Young
- Abstract
Background and Aim Without effective prophylaxis, liver transplantation ( LT) for hepatitis B virus ( HBV)-related liver disease is frequently complicated by severe and rapidly progressive HBV recurrence. The combination of low-dose hepatitis B immunoglobulin ( HBIG) and the new nucleos(t)ide analog, entecavir, as prophylaxis for HBV recurrence after living-donor LT ( LDLT) were analyzed. Methods A total of 315 patients with positive hepatitis B surface antigen underwent LDLT at our transplant center between July 2003 and December 2011. Our protocol for post-transplantation HBV prophylaxis was a combination of low-dose HBIG and nucleos(t)ide analog. Results During a median follow-up period of 49 months post-transplant, 10 patients (3.2%) had HBV recurrence, which was significantly related to hepatocellular carcinoma ( HCC) at transplantation ( P = 0.041) and post- LT antiviral agent ( P < 0.001) in multivariate analysis. The level of HBV DNA and hepatitis B e antigen state at transplantation were not significant factors for HBV recurrence ( P = 0.342 and P = 0.802, respectively). In 170 patients with HCC at LDLT, HCC recurrence was significantly related to HBV recurrence ( P < 0.001). Among 10 patients with HBV recurrence, three are alive and two had lost hepatitis B surface antigen. The remaining seven patients died of HCC recurrence. Conclusions The combination of low-dose HBIG and nucleos(t)ide analogs is safe and effective for HBV prophylaxis after LDLT. As a post- LT antiviral treatment, entecavir is more effective than lamivudine. HCC at transplantation was significantly associated with HBV recurrence. HBV-related HCC patients who undergo LDLT require close virological monitoring.
- Subjects
HEPATITIS B; IMMUNOGLOBULINS; LIVER cancer; LIVER transplantation; NUCLEOSIDES
- Publication
Journal of Gastroenterology & Hepatology, 2014, Vol 29, Issue 1, p151
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/jgh.12403