Rational Basis for Optimizing Short and Long-term Hepatitis B Virus Prophylaxis Post Liver Transplantation: Role of Hepatitis B Immune Globulin
Identifieur interne : 000121 ( Main/Exploration ); précédent : 000120; suivant : 000122Rational Basis for Optimizing Short and Long-term Hepatitis B Virus Prophylaxis Post Liver Transplantation: Role of Hepatitis B Immune Globulin
Auteurs : Bruno Roche [France] ; Anne Marie Roque-Afonso [France] ; Frederik Nevens [Belgique] ; Didier Samuel [France]Source :
- Transplantation [ 0041-1337 ] ; 2015.
Abstract
Antiviral therapy using newer nucleos(t)ide analogues with lower resistance rates, such as entecavir or tenofovir, suppress hepatitis B virus (HBV) replication, improve liver function in patients with compensated or decompensated cirrhosis, and delay or obviate the need for liver transplantation in some patients. After liver transplantation, the combination of long-term antiviral and low-dose hepatitis B Immune globulin (HBIG) can effectively prevent HBV recurrence in greater than 90% of transplant recipients. Some forms of HBV prophylaxis need to be continued indefinitely after transplantation but, in patients with a low-risk of HBV recurrence (i.e., HBV DNA levels undetectable before transplantation), it is possible to discontinue HBIG and maintain only long-term nucleos(t)ide analogue(s) therapy. A more cautious approach is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e., HIV or hepatitis D virus coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.
Url:
DOI: 10.1097/TP.0000000000000777
PubMed: 26038873
PubMed Central: 4539198
Affiliations:
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Le document en format XML
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<series><title level="j">Transplantation</title>
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<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<p>Antiviral therapy using newer nucleos(t)ide analogues with lower resistance rates, such as entecavir or tenofovir, suppress hepatitis B virus (HBV) replication, improve liver function in patients with compensated or decompensated cirrhosis, and delay or obviate the need for liver transplantation in some patients. After liver transplantation, the combination of long-term antiviral and low-dose hepatitis B Immune globulin (HBIG) can effectively prevent HBV recurrence in greater than 90% of transplant recipients. Some forms of HBV prophylaxis need to be continued indefinitely after transplantation but, in patients with a low-risk of HBV recurrence (i.e., HBV DNA levels undetectable before transplantation), it is possible to discontinue HBIG and maintain only long-term nucleos(t)ide analogue(s) therapy. A more cautious approach is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e., HIV or hepatitis D virus coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.</p>
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<name sortKey="Roque Afonso, Anne Marie" sort="Roque Afonso, Anne Marie" uniqKey="Roque Afonso A" first="Anne Marie" last="Roque-Afonso">Anne Marie Roque-Afonso</name>
<name sortKey="Roque Afonso, Anne Marie" sort="Roque Afonso, Anne Marie" uniqKey="Roque Afonso A" first="Anne Marie" last="Roque-Afonso">Anne Marie Roque-Afonso</name>
<name sortKey="Roque Afonso, Anne Marie" sort="Roque Afonso, Anne Marie" uniqKey="Roque Afonso A" first="Anne Marie" last="Roque-Afonso">Anne Marie Roque-Afonso</name>
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<country name="Belgique"><noRegion><name sortKey="Nevens, Frederik" sort="Nevens, Frederik" uniqKey="Nevens F" first="Frederik" last="Nevens">Frederik Nevens</name>
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