medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2011, Number 2

<< Back Next >>

Ann Hepatol 2011; 10 (2)

Does pre-liver transplant HBV DNA level affect HBV recurrence or survival in liver transplant recipients receiving HBIg and nucleos(t)ide analogues?

Campos-Varela I, Castells L, Buti M, Vargas V, Bilbao I, Rodríguez-Frías F, Jardí R, Charco R, Guardia J, Esteban R

Language: English
References: 39
Page: 180-187
PDF size: 105.79 Kb.


ABSTRACT

Background and Aims. The risk of recurrent hepatitis B virus (HBV) infection and prognosis of liver transplantation in patients with HBV has dramatically changed with the use of prophylaxis including hepatitis B immune globulin (HBIg) and antiviral agents. Methods. This study analyzes the prognostic value of HBV DNA level before orthotopic liver transplantation (OLT) and the effect of HBV prophylaxis on rates of HBV recurrence and survival. Between 1988 and 2008, 859 patients underwent OLT in our center; 60 patients had HBV-related liver disease and in 49, HBV DNA was determined by real time-PCR before OLT. Survival and HBV recurrence were analyzed according to preoperative viral load (HBV DNA ‹103 IU/mL vs. HBV DNA ≥103) and prophylaxis regimens (HBIg vs HBIg and antivirals). Results. On multivariate analysis, prophylaxis with HBIg alone, but not HBV-DNA levels was independently associated with poor survival, with a relative risk (RR) of death of 6.5 (95% CI 2.1-19.8, P = 0.001). The risk of HBV recurrence, in this small series, was also associated with monoprophylaxis with HBIg (RR 27, 95% CI 5.2-147.2, P ‹ 0.0001), but not with HBV-DNA levels. Conclusions. When prophylaxis with HBIg and antiviral agents was administered, survival and HBV recurrence were not influenced by HBV-DNA levels determined by real time-PCR prior to OLT.


REFERENCES

  1. Samuel D, Muller R, Alexander G, et al. Liver transplantation in European patients with the hepatitis B surface antigen. New Engl J Med 1993; 329: 1842-7.

  2. Devlin J, Smith HM, O’Grady JG, et al. Impact of immunoprophylaxis and patient selection on outcome of transplantation for HBsAg-positive liver recipients. J Hepatol 1994; 21: 204-10.

  3. Roche B, Samuel D. Liver transplantation for hepatitis B virus-related liver disease: Indications, prevention of recurrence and results. J Hepatol 2003; S181-S189.

  4. Marzano A. The prevention of viral recurrence in the long term. Dig Liver Dis 2009; 41(Suppl.)2: S195-S197.

  5. Saab S, Yam MY, Stone MA, et al. Decision analisis model for hepatitis B prophylaxis one year after liver transplantation. Liver Transpl 2009; 15: 413-20.

  6. Marzano A, Salizzoni M, Debernardi-Venon W, et al. Prevention fo hepatits B recurrence after liver transplantation in cirrhotic patients treated with lamivudine and passive immunoprophylaxis. J Hepatol 2001; 34: 903-10.

  7. Markowitz JS, Martin P, Conrad AJ, et al. Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin. Hepatology 1998; 28: 585-9.

  8. Grellier L, Multimer D, Ahmed M, et al. Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis. Lancet 1996; 348: 1212-1215.

  9. Grellier L, Dusheiko GM. Hepatitis B virus and liver transplantation: concepts in antiviral prophylaxis. J Viral Hepat 1997; 4(Suppl. 1): 111-6.

  10. Shouval D, Samuel D. Hepatitis B immune globulin to prevent hepatitis B virus graft reinfection following liver transplantation: a concise review. Hepatology 2000; 32: 1189-95.

  11. Buti M, Castells L, Campos I, et al. Prevention of HBV recurrence after liver transplant: The role of combination therapy. Dig Liver Dis 2009; 4 (Suppl. 3): S98-S103.

  12. Roche B, Feray C, Gigou M et al. HBV DNA persistence 10 years after liver transplantation despite successful anti-HBS passive immunoprophylaxis. Hepatology 2003; 38: 86-95.

  13. Buti M, Mas A, Prieto M, et al. A randomized study comparing lamivudine monotherapy after a short course of hepatitis B immune globulin (HBIg) and lamivudine with long-term lamivudine plus HBIg in the prevention of hepatitis B virus recurrence after liver transplantation. J Hepatol 2003; 38: 811-17.

  14. Buti M, Mas A, Prieto M, et al. Adherence to Lamivudine after an early withdrawal of hepatitis B immune globulin plays an important role in the long-term prevention of hepatitis B virus recurrence. Transplantation 2007; 84: 650-4.

  15. Marzano A, Gaia S, Ghisetti V, et al. Viral Load at the Time of Liver Transplantation and Risk of Hepatitis B Virus Recurrence. Liver Transpl 2005; 11: 402-9.

  16. Beckebaum S, Sotiropoulos GC, Klein CG, et al. Predictive Factors of Outcome in Patients Transplanted for Hepatitis B. Transplantation 2009; 87: 872-81.

  17. Marzano A, Ciancio A, Salizzoni M, et al. Hepatitis B virus subtypes and lamivudine resistance. Lancet 2001; 358: 153-4.

  18. Marzano A, Lampertico P, Mazzaferro V, et al. Prophylaxis of hepatitis B virus recurrence after liver transplantation in carriers of lamivudine-resistant mutants. Liver Transpl 2005; 11: 532-8.

  19. Schiff ER, Lai CL, Hadziyannis S, et al. Adefovir dipivoxil therapy for lamivudine-resistant hepatitis B in pre- and post-liver transplantation patients. Hepatology 2003; 38: 1419-27.

  20. Peters MG, Singer G, Howard T, et al. Fulminant hepatic failure resulting from lamivudine-resistant hepatitis B virus in a renal transplant recipient: durable response after orthotopic liver transplantation on adefovir dipivoxil and hepatitis B immune globulin. Transplantation 1999; 68: 1912-14.

  21. Seehofer D, Rayes N, Steinmuller T, et al. Liver transplantation in hepatitis B patients with preoperative resistance formation during lamivudine treatment. Transplant Proc 2002; 34: 2274-5.

  22. Bartholomew MM, Jansen RW, Jeffers LJ, et al. Hepatitis- B-virus resistance to lamivudine given for recurrent infection after orthotopic liver transplantation. Lancet 1997; 349: 20-2.

  23. de-Man RA, Bartholomeusz AI, Niesters HG, et al. The sequential occurrence of viral mutations in a liver transplant recipient re-infected with hepatitis B: hepatitis B immune globulin escape, famciclovir non-response, followed by lamivudine resistance resulting in graft loss. J Hepatol 1998; 29: 669-75.

  24. Lerut JP, Donataccio M, Ciccarelli O, et al. Liver transplantation and HBsAg positive postnecrotic cirrhosis: adequate immunoprophylaxis and delta virus co-infection as the signi?cant determinants of long-term prognosis. J Hepatol 1999; 30: 706-14.

  25. Samuel D, Zignego AL, Reynes M, et al. Long-term clinical and virological outcome after liver transplantation for cirrhosis caused by chronic delta hepatitis. Hepatology 1995; 21: 333-9.

  26. Papatheodoridis GV, Cholongitas E, Archimandritis AJ, et al. Current management of hepatitis B virus infection before and after liver transplantation. Liver Int 2009; 29(9): 1294-305.

  27. Angus PW, Patterson SJ. Liver transplantation for hepatitis B: what is the best hepatitis B immune globulin/antiviral regimen? Liver Transplant 2008; 14: S15-S22.

  28. Steinmüller T, Seehofer D, Rayes N, et al. Increasing Applicability of Liver Transplantation for Patients With Hepatitis B– Related Liver Disease. Hepatology 2002; 35: 1528-35.

  29. Shi-Bin Xie, Jian-Yun Zhu, Zhang Ying, et al. Prevention and risk factors of the HBV recurrence after orthotopic liver transplantation: 160 Cases Follow-Up Study. Transplantation 2010; 90: 786-90.

  30. Jardi R, Rodríguez F, Buti M, et al. Quantitative detection of hepatitis B virus DNA in serum by a rapid real- time fluorescence PCR assay. J Viral Hepat 2001; 8: 465-71.

  31. Faust D, Rabenau HF, Allwinn R, et al. Cost-effective and safe ambulatory long-term immunoprophylaxis with intramuscular instead of intravenous hepatitis B immunoglobulin to prevent reinfection after orthotopic liver transplantation. Clin Transplant 2003; 17(3): 254-8.

  32. Han SH, Martin P, Edelstein M, et al. Conversion from intravenous to intramuscular hepatitis B immune globulin in combination with lamivudine is safe and cost-effective in patients receiving long-term prophylaxis to prevent hepatitis B recurrence after liver transplantation. Liver Transpl 2003; 9(2): 182-7.

  33. Castells L, Campos-Varela I, Buti M, et al. Pharmacokinetics of intramuscular and intravenous HBIg: Which implications for practice? Dig Liver Dis 2009; 4(Suppl. 3): S119-S123.

  34. Todo S, Demetris AJ, Van Thiel D, et al. Orthotopic liver transplantation for patients with hepatitis B virus-related liver disease. Hepatology 1991; 13: 619-26.

  35. Neff GW, O’Brien CB, Nery J, et al. Outcomes in liver transplant recipients with hepatitis B virus: resistance and recurrence patterns from a large transplant center over the last decade. Liver Transpl 2004; 10: 1372-8.

  36. McCaughan GW, Spencer J, Koorey D, et al. Lamivudine therapy in patients undergoing liver transplantation for hepatitis B virus precore mutant-associated infection: high resistance rates in treatment of recurrence but universal prevention if used as prophylaxis with very low dose hepatitis B immune globulin. Liver Transplant Surg 1999; 5: 512-19.

  37. Faria LC, Gigou M, Roque-Afonso AM, et al. Hepatocellular carcinoma is associated with an increased risk of hepatitis B recurrence after liver transplantation. Gastroenterology 2008; 134: 1890-1899.

  38. Saab S, Yeganen M, Nguyen K, et al. Recuurence of hepatocellular carcinoma and hepatitis B reinfection in hepatitis B surface antigen-positive patients after liver transplantation. Liver Transpl 2009; 15: 1525-34.

  39. Wong DK, Yuen MF, Poon RT, et al. Quantification of hepatitis B virus covalently closed circular DNA in patients with hepatocellular carcinoma. J Hepatol 2006; 45: 553-9.




2020     |     www.medigraphic.com