Long-Term Outcomes of Entecavir Monotherapy for Chronic Hepatitis B after Liver Transplantation: Results up to 8 years

Abstract

Long-term antiviral prophylaxis is required to prevent hepatitis B recurrence for patients with chronic hepatitis B (CHB) after liver transplantation. We determined the long-term outcome of 265 consecutive CHB liver transplant recipients treated with entecavir monotherapy without hepatitis B immune globulin (HBIG). Viral serology, viral load, and liver biochemistry were performed at regular intervals during follow-up. The median duration of follow up was 59 months. The cumulative rates of hepatitis B surface antigen (HBsAg) seroclearance were 90% and 95% at 1 and 5 years respectively. At year 1, 3, 5, and 8 years, 85%, 88%, 87.0% and 92% were negative for HBsAg respectively, and 95%, 99%, 100%, and 100% had undetectable HBV DNA respectively. Fourteen patients remained persistently positive for HBsAg, all of which had undetectable HBV DNA. There was no significant difference in liver stiffness for those who remains HBsAg positive compared to those who achieved HBsAg seroclearance (5.5 vs 5.2 kPa respectively, p=0.52). There was no virological rebound observed for the entire cohort. The overall 9-year survival was 85%. There were 37 deaths during the follow-up period, of which none were due to hepatitis B recurrence. CONCLUSIONS: Long-term entecavir monotherapy is highly effective in preventing HBV reactivation after liver transplantation for CHB, with durable HBsAg seroclearance rate of 92% and undetectable HBV DNA rate of 100% at 8 years, and excellent long-term survival of 85% at 9 years. This article is protected by copyright. All rights reserved.