Anti-virus prophylaxis withdrawal may be feasible in liver transplant recipients whose serum HBeAg and HBV DNA are negative

doi:10.1016/S1499-3872(16)60087-5

Hepatobiliary & Pancreatic Diseases International

Volume 15, Issue 3, June 2016, Pages 316-318

https://doi.org/10.1016/S1499-3872(16)60087-5 Get rights and content

Abstract

Anti-virus prophylactic therapy may be not necessary for the prevention of hepatitis B virus (HBV) recurrence after HBV-related liver transplantation (LT). However, studies on completely stopping the hepatitis B immune globulin (HBIG) and nucleos(t)ide analogs (NUC) after LT are few. The aim of the current study was to evaluate the safety of anti-virus prophylaxis withdrawal in liver recipients whose serum hepatitis B e antigen (HBeAg) and HBV DNA are negative. We analyzed 190 patients undergone LT for HBV-related liver disease from 2006 to 2012 and found that 10 patients completely stopped the HBIG and NUC due to poor compliance. These patients were liver biopsied and checked monthly with serum HBV markers, HBV DNA and liver function. Among the 10 patients, 9 did not show the signs of HBV recurrence after a mean follow-up of 51.6 months (range 20-73) after withdrawal of the HBIG and NUC. The average time from LT to the withdrawal of the anti-virus drug was 23.8 (13-42) months; one patient showed hepatitis B surface antigen-positive and detectable HBV DNA after stopping anti-virus drugs and this patient was successfully treated with entecavir. Our data suggested that complete withdrawal of anti-virus prophylaxis was safe and feasible for patients whose serum HBeAg and HBV DNA were negative at the time of LT.

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Cited by (7)

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Hepatitis B and C are common causes of end-stage liver disease and etiologies of liver transplantation. It is important to prevent recurrence in cases of hepatitis B. Nucleos(t)ide analogs are the mainstay of HBV treatment before (in patients with decompensated cirrhosis) and after liver transplantation. After the introduction of direct-acting antivirals, the treatment of HCV has become considerably easy. In patients with advanced HCV-related cirrhosis, it is better to do transplantation first and treat them after liver transplantation. The sustained virological response rates have improved from 8 to 50% in the interferon era to 90% in the direct-acting antivirals era. In the current review, we discuss the treatment of HBV and HCV before and after liver transplantation.
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Citation Excerpt :
Remarkably, 80% remained without evidence of HBV recurrence and 90% off any HBV therapy with at least 6 years of follow-up and, interestingly, 60% had developed anti-HBs (median titer, 143 U/L).67 Another study from China reported on the long-term outcomes of 10 patient stopping HBIG and lamivudine owing to nonadherence 13 to 42 months after LT and 9 of the 10 remained without evidence of HBV infection.68 Donor HBV status was not reported in this latter study.
Consensus document of the Spanish Association for Study of the Liver on the treatment of hepatitis B virus infection (2020)
2020, Gastroenterologia y Hepatologia
La infección por el virus de la hepatitis B (VHB) continúa siendo un problema global de salud pública. La vacunación frente al VHB, introducida en España en la década de 1990, constituye el método más eficaz para reducir la incidencia de la enfermedad. No obstante, la migración procedente de países donde la prevalencia de la infección es alta contribuye a que en nuestro país la tasa esté aún entre el 0,5 y el 1%. El espectro de la enfermedad crónica ocasionada por el VHB es muy variable y abarca desde el portador inactivo a pacientes con hepatitis crónica, cirrosis y carcinoma hepatocelular. A pesar de que en los últimos años no se han producido grandes avances en el desarrollo clínico de nuevos fármacos para el tratamiento de la hepatitis B crónica, los cambios en la epidemiología, en el conocimiento de la historia natural, métodos diagnósticos e indicaciones de tratamiento aconsejan la actualización del documento de consenso de la Asociación Española para el Estudio del Hígado (AEEH) sobre el tratamiento de la infección por el VHB publicado en el año 2012. El documento de la AEEH revisa el tratamiento de la hepatitis B crónica y establece como mejor pauta la administración prolongada de un análogo de nucleós(t)ido con alta barrera genética a la resistencia (entecavir, tenofovir o tenofovir alafenamida). El interferón-pegilado constituye una alternativa en pacientes con enfermedad hepática poco avanzada, pero su aplicabilidad es limitada por su baja eficacia y efectos adversos frecuentes. En todos los pacientes se debe evaluar el riesgo de progresión a enfermedad hepática avanzada y de desarrollo de carcinoma hepatocelular. Determinados subgrupos de pacientes con infección crónica por VHB deben ser incluidos en programas de vigilancia para el diagnóstico precoz de carcinoma hepatocelular, que constituye en el momento actual la principal complicación de la enfermedad.
Hepatitis B virus (HBV) infection remains a global public health problem. HBV vaccination is the most effective tool to reduce the incidence of HBV disease. Despite there has not been new clinical developments for the treatment of chronic hepatitis B in the last few years, changing epidemiology and current insights on natural history, diagnostic tools and therapy indications make necessary an update of the former version of the consensus document of the Spanish Association for Study of the Liver on the treatment of hepatitis B infection published in 2012. The current document updates the management of chronic hepatitis B. The treatment of choice is the long-term administration of a nucleos(t)ide analogue with high barrier to resistance (entecavir, tenofovir or tenofovir alafenamide). Pegylated interferon may be an option in patients with non-advanced liver disease, but its applicability is limited due to the low efficacy and poor tolerability. All patients must be monitored for the risk of progression to advanced liver disease and development of hepatocellular carcinoma.
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: Published online April 20, 2016.

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Brief ReportAnti-virus prophylaxis withdrawal may be feasible in liver transplant recipients whose serum HBeAg and HBV DNA are negative

Abstract

J Hepatol

Gastroenterology

Am J Transplant

J Hepatol

Hepatobiliary Pancreat Dis Int

Brief Report
Anti-virus prophylaxis withdrawal may be feasible in liver transplant recipients whose serum HBeAg and HBV DNA are negative