期刊
CLINICAL TRANSPLANTATION
卷 37, 期 6, 页码 -出版社
WILEY
DOI: 10.1111/ctr.14971
关键词
hepatitis B virus; hepatitis D virus; immunoglobulins; liver transplantation; withdrawal
This study analyzed the long-term outcomes of 16 patients transplanted for HDV/HBV-related cirrhosis who discontinued HBIg after a median of 24.5 months. The results showed that monoprophylaxis with NA was effective in preventing HDV/HBV infection recurrence. In addition, 50% of the patients developed spontaneous serological immunity against HBV after HBIG discontinuation. Therefore, this study suggests the reconsideration of current prophylactic recommendations in this setting.
BackgroundIndefinite, long-term administration of hepatitis B immunoglobulins (HBIg), together with a third generation nucleos(t)ide analog (NA), is the currently recommended prophylactic strategy to prevent viral recurrence after liver transplantation (LT) for Hepatitis Delta virus (HDV)/Hepatitis B virus (HBV)-related disease. MethodsWe retrospectively analyzed the safety and long-term clinical and virological outcomes of a consecutive cohort of 16 patients (10 males, median age 64.5, range 41-75) transplanted for HDV/HBV-related cirrhosis at our Institution, who discontinued HBIg after a median of 24.5 months (range 15-116) after transplant. All patients continued prophylaxis with same NA used before LT. Recurrence of HDV/HBV infection was defined as reappearance of serum HDV-RNA with detectable serum HBsAg and/or HBV-DNA. ResultsThe median follow-up after LT was 138 months (range 73-316) and 110 months (range 52-200) after HBIg withdrawal. All patients were HBsAg-positive, HBV-DNA negative, and anti-HDV positive at the time of LT and without coinfections with HCV or HIV. Patients were followed with biochemical and virological tests every 3-6 months after HBIg withdrawal. No recurrences of HDV/HBV infection or disease were observed during monoprophylaxis with NA. In addition, eight patients (50%) spontaneously developed anti-HBs titers above 10 IU/L at a median of 74 months (range 58-140) following HBIG discontinuation. ConclusionsHBIg withdrawal after LT is a safe and efficacious strategy in patients transplanted for HDV/HBV disease and is frequently associated with the spontaneous development of serological immunity against HBV. These data call for a revision of current prophylactic recommendations in this setting.
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