Comparison of Different Immunoprophylaxis Regimens After Liver Transplantation with Hepatitis B Core Antibody-Positive Donors: A Systematic Review

Orthotopic liver transplantation (OLT) recipients without hepatitis B virus (HBV) Infection who receive liver grafts from antibody to hepatitis B core antigen-positive [HBcAb(+)], hepatitis B surface antigen-negative [HBsAg(-)] donors have an increased risk of developing de novo hepatitis B infection We compared the 2 most commonly employed prophylactic regimens-lamivudine (LAM) monotherapy and hepatitis B immunoglobulin (HBIG)+LAM combination therapy-to determine the relative efficacies of these 2 protocols in preventing de novo hepatitis B infection. A comprehensive search of the Cochrane Database of Systematic. Reviews, MEDLINE (1966 to June 2009), and bibliographies of retrieved trials was conducted. Eligible studies included OLT recipients who received HBcAb(+) liver grafts and were treated prophylactically with either LAM monotherapy or HBIG+LAM combination therapy 13 studies were identified as meeting the eligibility criteria The rates of de novo hepatitis B infection, mortality, and mortality due to de novo hepatitis B infection were assessed The incidence of de novo hepatitis B infection was 2 7% (n = 73) in patients receiving LAM-only prophylaxis versus 3 6% (n = 110) in patients receiving HBIG+LAM combination therapy In the HBIG-I LAM group, the dose and duration of HBIG therapy were highly variable The median follow-up time for the LAM monotherapy group was 25.4 months with a range of 14 78 to 27 6 months, whereas the median follow-up time for the LAM+HBIG group was 31 1 months with a range of 15 3 to 38 5 months The risk of developing de novo hepatitis B infection based on the pretransplant recipient HBV serology in each treatment group could not be calculated because of incomplete data and the limited number of de novo hepatitis B infection cases in the series reviewed In conclusion, on the basis of these findings, we conclude that published studies have not shown HBIG+LAM combination therapy to be more effective than LAM-only treatment Nucleoside analogue monotherapy should therefore be considered when one is treating HBV(-) patients who have received liver allografts from HBcAb(-) donors Liver Transpl 16:300-307, 2010. (C) 2010 AASLD.