*Purpose: Hepatitis B virus infection is a worldwide concern with a broad distribution. It can reactivate in immunocompromised populations such as solid organ and hematopoietic stem cell transplant (HSCT) recipients, leading to acute hepatic failure. Different risk factors are known for higher risk of reactivation and entecavir, tenofovir, and lamivudine are often used for prophylaxis in this context. However, data regarding the impact of antiviral drugs in neutrophil and platelet engraftment are still scarce and complicates the management of viral hepatitis post-HSCT.

*Methods: We performed a single-center retrospective observational study of adult HSCT from 2010 to 2017, aiming to describe outcomes related to antiviral treatment for HBV and the impact on platelet and neutrophil recovery after transplant. Participants were adults with positive screening for Hepatitis B infection, confirmed by a second serology test. A total of 1132 hematopoietic stem cell recipients were evaluated.

*Results: 86 patients were confirmed to have HBV infection in the cohort, mostly resolved or isolated anti-HBc. With regards to prophylaxis, 19 patients underwent HSCT using HBV antiviral drugs, from which 2 were HBeAg-positive, 3 were HBeAg-negative and HBV-DNA was only detectable in 3 of them. Moreover, one patient had an occult HBV infection. As for therapy, 9 patients were prescribed entecavir, 6 patients lamivudine, 2 tenofovir and 2 were on a combination of tenofovir + lamivudine (due to HIV co-infection). Reverse seroconversion was not identified in any patients receiving antiviral therapy, although it was detected in one patient with occult hepatitis B and in another with resolved infection. No severe side effects occurred in the treated group, and there was no significant delay in neutrophil or platelet engraftment when compared to patients without antiviral use. The factors linked to increased mortality were: age at transplant over 50 years, allogeneic transplant and myeloablative conditioning regimens. Interestingly, the presence of HBsAg or detectable HBV-DNA was not related to worse outcomes, nor the use of Rituximab.

*Conclusions: HBV serology, ALT and HBV-DNA monitoring are essential to prevent hepatic flares, even in populations with chronic inactive hepatitis due to the possibility of late seroconversion. Antiviral prophylaxis did not cause any important side effects or biochemical abnormalities that would prompt discontinuation, and its use was not related to later neutrophil and platelet engraftment.

« Back to 2020 American Transplant Congress