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Successful clinical and virological outcomes of liver transplantation for HDV/HBV-related disease after long-term discontinuation of hepatitis B immunoglobulins.
- Source :
-
Clinical transplantation [Clin Transplant] 2023 Jun; Vol. 37 (6), pp. e14971. Date of Electronic Publication: 2023 Mar 17. - Publication Year :
- 2023
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Abstract
- Background: Indefinite, 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.<br />Methods: We 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.<br />Results: The 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.<br />Conclusions: HBIg 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.<br /> (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Male
Humans
Child, Preschool
Child
Hepatitis B virus genetics
Antiviral Agents therapeutic use
Hepatitis B Surface Antigens
Retrospective Studies
DNA, Viral genetics
Treatment Outcome
Immunoglobulins therapeutic use
Hepatitis B Antibodies
Liver Transplantation adverse effects
Hepatitis B complications
Subjects
Details
- Language :
- English
- ISSN :
- 1399-0012
- Volume :
- 37
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Clinical transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 36928864
- Full Text :
- https://doi.org/10.1111/ctr.14971