Entecavir or tenofovir monotherapy prevents HBV recurrence in liver transplant recipients: A 5-year follow-up study after hepatitis B immunoglobulin withdrawal

Matteo A. Manini, Gavin Whitehouse, Matthew Bruce, Matteo Passerini, Tiong Y. Lim, Ivana Carey, Aisling Considine, Pietro Lampertico, Abid Suddle, Nigel Heaton, Michael Heneghan, Kosh Agarwal

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Recent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT). Patients and methods: Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. Results: Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Groups A and B patients were followed for 69 (range 13–83) months and 61 (range 31–78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1–40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. Conclusion: HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.

Original languageEnglish
Pages (from-to)944-953
JournalDigestive and Liver Disease
Volume50
Issue number9
DOIs
Publication statusPublished - 2018

Fingerprint

Tenofovir
Hepatitis B
Immunoglobulins
Recurrence
Liver
Hepatitis B Surface Antigens
Liver Transplantation
Transplant Recipients
entecavir

Keywords

  • Antiviral drug-resistance mutation
  • HBsAg titre
  • HBV DNA level
  • Hepatocellular carcinoma
  • Safety

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Entecavir or tenofovir monotherapy prevents HBV recurrence in liver transplant recipients : A 5-year follow-up study after hepatitis B immunoglobulin withdrawal. / Manini, Matteo A.; Whitehouse, Gavin; Bruce, Matthew; Passerini, Matteo; Lim, Tiong Y.; Carey, Ivana; Considine, Aisling; Lampertico, Pietro; Suddle, Abid; Heaton, Nigel; Heneghan, Michael; Agarwal, Kosh.

In: Digestive and Liver Disease, Vol. 50, No. 9, 2018, p. 944-953.

Research output: Contribution to journalArticle

Manini, Matteo A. ; Whitehouse, Gavin ; Bruce, Matthew ; Passerini, Matteo ; Lim, Tiong Y. ; Carey, Ivana ; Considine, Aisling ; Lampertico, Pietro ; Suddle, Abid ; Heaton, Nigel ; Heneghan, Michael ; Agarwal, Kosh. / Entecavir or tenofovir monotherapy prevents HBV recurrence in liver transplant recipients : A 5-year follow-up study after hepatitis B immunoglobulin withdrawal. In: Digestive and Liver Disease. 2018 ; Vol. 50, No. 9. pp. 944-953.
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abstract = "Background: Recent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT). Patients and methods: Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. Results: Seventy-seven patients were included in the study (55{\%} TDF, 45{\%} ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Groups A and B patients were followed for 69 (range 13–83) months and 61 (range 31–78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9{\%}) Group A patients became HBsAg-positive after a median of 18 (range 1–40) months. The cumulative 5-year incidence of HBsAg recurrence was 9{\%}. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. Conclusion: HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.",
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T1 - Entecavir or tenofovir monotherapy prevents HBV recurrence in liver transplant recipients

T2 - A 5-year follow-up study after hepatitis B immunoglobulin withdrawal

AU - Manini, Matteo A.

AU - Whitehouse, Gavin

AU - Bruce, Matthew

AU - Passerini, Matteo

AU - Lim, Tiong Y.

AU - Carey, Ivana

AU - Considine, Aisling

AU - Lampertico, Pietro

AU - Suddle, Abid

AU - Heaton, Nigel

AU - Heneghan, Michael

AU - Agarwal, Kosh

PY - 2018

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N2 - Background: Recent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT). Patients and methods: Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. Results: Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Groups A and B patients were followed for 69 (range 13–83) months and 61 (range 31–78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1–40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. Conclusion: HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.

AB - Background: Recent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT). Patients and methods: Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. Results: Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Groups A and B patients were followed for 69 (range 13–83) months and 61 (range 31–78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1–40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. Conclusion: HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.

KW - Antiviral drug-resistance mutation

KW - HBsAg titre

KW - HBV DNA level

KW - Hepatocellular carcinoma

KW - Safety

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