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Article: Oral nucleoside/nucleotide analogs without hepatitis b immune globulin after liver transplantation for hepatitis b

TitleOral nucleoside/nucleotide analogs without hepatitis b immune globulin after liver transplantation for hepatitis b
Authors
Issue Date2013
Citation
American Journal of Gastroenterology, 2013, v. 108, n. 6, p. 942-948 How to Cite?
AbstractOBJECTIVES:The long-term outcomes of oral antiviral therapy without hepatitis B immune globulin (HBIG) in prevention of reinfection with hepatitis B after liver transplantation are not known. We aimed to determine the long-term outcomes from a large population of chronic hepatitis B (CHB) liver transplant recipients using oral antiviral therapy alone.METHODS:A total of 362 consecutive CHB patients transplanted from January 2003 to May 2011 were included. None of the patients received HBIG. Viral serology, viral load, and liver biochemistry were performed at regular intervals during follow-up.RESULTS:Of the 362 patients, 176 (49%), 142 (39%), and 44 (12%) were on lamivudine (LAM), entecavir (ETV), and combination therapy (predominantly LAM+adefovir), respectively, at the time of transplant. The median follow-up length was 53 months. The rate of hepatitis B surface antigen seronegativity and hepatitis B virus (HBV) DNA suppression to undetectable levels at 8 years was 88 and 98%, respectively. The virological relapse rates (>1 log increase IU/ml) at 1, 3, 5, and 8 years was 5, 10, 13 and 16%, respectively. The virological relapse rate at 3 years for LAM, ETV, and combination group was 17, 0, and 7%, respectively (P<0.001). Forty-two patients had virological relapse, of which 36 had YMDD mutation (31 in the LAM group and 5 in the combination group). The overall 8-year survival was 83%, with no difference between the three treatment groups (P=0.94). No mortality from HBV recurrence occurred in the 362 patients.CONCLUSIONS:Oral nucleoside/nucleotide analogs without HBIG are effective in preventing graft loss secondary to hepatitis B recurrence after liver transplantation. However, new agents with a high barrier to resistance should be used to minimize drug resistance and to prevent virological rebound. ©2013 by the American College of Gastroenterology.
Persistent Identifierhttp://hdl.handle.net/10722/221340
ISSN
2015 Impact Factor: 10.383
2015 SCImago Journal Rankings: 3.946

 

DC FieldValueLanguage
dc.contributor.authorFung, J-
dc.contributor.authorChan, SC-
dc.contributor.authorCheung, C-
dc.contributor.authorYuen, MF-
dc.contributor.authorChok, KSH-
dc.contributor.authorSharr, W-
dc.contributor.authorChan, ACY-
dc.contributor.authorCheung, TT-
dc.contributor.authorSeto, WK-
dc.contributor.authorFan, ST-
dc.contributor.authorLai, CL-
dc.contributor.authorLo, CM-
dc.date.accessioned2015-11-18T06:09:03Z-
dc.date.available2015-11-18T06:09:03Z-
dc.date.issued2013-
dc.identifier.citationAmerican Journal of Gastroenterology, 2013, v. 108, n. 6, p. 942-948-
dc.identifier.issn0002-9270-
dc.identifier.urihttp://hdl.handle.net/10722/221340-
dc.description.abstractOBJECTIVES:The long-term outcomes of oral antiviral therapy without hepatitis B immune globulin (HBIG) in prevention of reinfection with hepatitis B after liver transplantation are not known. We aimed to determine the long-term outcomes from a large population of chronic hepatitis B (CHB) liver transplant recipients using oral antiviral therapy alone.METHODS:A total of 362 consecutive CHB patients transplanted from January 2003 to May 2011 were included. None of the patients received HBIG. Viral serology, viral load, and liver biochemistry were performed at regular intervals during follow-up.RESULTS:Of the 362 patients, 176 (49%), 142 (39%), and 44 (12%) were on lamivudine (LAM), entecavir (ETV), and combination therapy (predominantly LAM+adefovir), respectively, at the time of transplant. The median follow-up length was 53 months. The rate of hepatitis B surface antigen seronegativity and hepatitis B virus (HBV) DNA suppression to undetectable levels at 8 years was 88 and 98%, respectively. The virological relapse rates (>1 log increase IU/ml) at 1, 3, 5, and 8 years was 5, 10, 13 and 16%, respectively. The virological relapse rate at 3 years for LAM, ETV, and combination group was 17, 0, and 7%, respectively (P<0.001). Forty-two patients had virological relapse, of which 36 had YMDD mutation (31 in the LAM group and 5 in the combination group). The overall 8-year survival was 83%, with no difference between the three treatment groups (P=0.94). No mortality from HBV recurrence occurred in the 362 patients.CONCLUSIONS:Oral nucleoside/nucleotide analogs without HBIG are effective in preventing graft loss secondary to hepatitis B recurrence after liver transplantation. However, new agents with a high barrier to resistance should be used to minimize drug resistance and to prevent virological rebound. ©2013 by the American College of Gastroenterology.-
dc.languageeng-
dc.relation.ispartofAmerican Journal of Gastroenterology-
dc.titleOral nucleoside/nucleotide analogs without hepatitis b immune globulin after liver transplantation for hepatitis b-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1038/ajg.2013.111-
dc.identifier.pmid23629601-
dc.identifier.scopuseid_2-s2.0-84878940734-
dc.identifier.hkuros214874-
dc.identifier.volume108-
dc.identifier.issue6-
dc.identifier.spage942-
dc.identifier.epage948-
dc.identifier.eissn1572-0241-

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