Introduction

The hypothesis of this study was that the long-term outcomes in liver transplant (LTx) patients with hepatitis B virus (HBV) who were treated with nucleos(t)ide inhibitors and no hepatitis B immune globulin (HBIg) maintenance can yield equal or greater efficacy than indefinite HBIg in preventing recurrent hepatitis B after LTx.

Methods and Results

Charts of patients who received LTx at our institution for HBV-related liver complications (cirrhosis, HCC, acute liver failure) were reviewed and analyzed retrospectively. There were 45 patients included in this study who received limited HBIg prophylaxis and were maintained on nucleos(t)ide inhibitors long-term. Mean follow up time was 4.8 years post-transplant (range 0.2 to 11 years), during which three patients (6.7%) developed recurrence of HBV, which was defined by presence of HBV DNA or positive hepatitis B surface antigen (HBsAg). Two of those patients became HBsAg positive while remaining HBV DNA negative. The third patient with recurrence became HBV DNA positive while remaining HBsAg negative and was found to be non-compliant with medication and became HBV DNA negative again once tenofovir was resumed.

Discussion

Our HBV recurrence rate at the end of the study was 6.7%. However, one instance of recurrence in our study was related to medication non-compliance. Once this patient resumed tenofovir, the HBV DNA level became undetectable and has remained negative, now 9.4 years post LTx. The clinical impact of HBV recurrence in our study seems to be minimal. Two of the three patients with recurrence have maintained excellent liver function after a mean 6 years follow up since recurrence. Only one patient with HBsAg positivity required retransplantation due to biliary strictures, not HBV recurrence. This patient's course can be explained by the well-known complication of biliary strictures that occurs in deceased donor LTx.

Conclusion

Indefinite HBIg therapy adds significant expense to the prevention of HBV post-LTx. Our regimen of nucleo(t)side inhibitors with no HBIg maintenance presents a safe, efficacious and cost-effective means to prevent recurrence of post-liver transplant HBV.

CITATION INFORMATION: Sievers T, Thompson J, Lake J. Limited Hepatitis B Immune Globulin Following Liver Transplant for Hepatitis B. Am J Transplant. 2016;16 (suppl 3).

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