Gastroenterology

Gastroenterology

Volume 141, Issue 4, October 2011, Pages 1212-1219
Gastroenterology

Original Research
Clinical—Liver
Entecavir Monotherapy Is Effective in Suppressing Hepatitis B Virus After Liver Transplantation

https://doi.org/10.1053/j.gastro.2011.06.083Get rights and content

Background & Aims

We investigated the efficacy of entecavir, a cyclopentyl guanosine nucleoside analogue, as monoprophylaxis in patients with chronic hepatitis B who received a liver transplant.

Methods

We studied data from 80 consecutive patients who received a liver transplant (47 from living donors and 33 from deceased donors) for hepatitis B–related disease and entecavir monotherapy as prophylaxis. None of the patients received hepatitis B immunoglobulin. Indications for transplant included decompensation from cirrhosis (27.5%), acute-on-chronic hepatitis B (47.5%), and hepatocellular carcinoma (25%). The median follow-up time was 26 months (range, 5–40 months). Before transplant, 33 patients were not on antiviral therapy and 47 were on oral therapy (18 had received less than 3 months of treatment).

Results

At the time of transplant, the median log HBV DNA level was 3.5 copies/mL (range, 1.54–8.81); 21 patients (26%) had undetectable levels of HBV DNA. The cumulative rate of hepatitis B surface antigen (HBsAg) loss was 86% and 91% after 1 and 2 years, respectively. Ten patients had reappearance of HBsAg. Eighteen patients (22.5%) were HBsAg positive at the time of their last examination; 17 of these had undetectable levels of HBV DNA, and the remaining patient had a low level of HBV DNA (217 copies/mL). There was no evidence of mutations at sites that confer resistance to entecavir among patients who were HBsAg positive.

Conclusions

Although only 26% of patients had complete viral suppression at the time of transplant, 91% lost HBsAg, with 98.8% achieving undetectable levels of HBV DNA. A hepatitis B immunoglobulin–free regimen of entecavir monotherapy is effective after liver transplantation for chronic hepatitis B.

Section snippets

Patients and Methods

All patients who underwent a liver transplant for CHB-related complications between November 2007 and December 2009 at Queen Mary Hospital, Hong Kong, were included in this study. A total of 80 patients were included. All were positive for HBsAg for at least 6 months at the time of transplant. As part of the revised protocol for HBV prophylaxis, all 80 patients received ETV as primary prophylaxis for the prevention of HBV recurrence. The standard dose of 0.5 mg daily was used in the majority,

Results

Eighty consecutive patients with CHB undergoing a liver transplant from November 2007 to December 2009 were included. Forty-seven patients (59%) underwent a liver transplant from a liver donor, with the remaining 33 patients (41%) receiving deceased donor grafts. The indications for transplant included decompensation from cirrhosis (27.5%), acute-on-chronic hepatitis B (47.5%), and HCC (25%). There was no operative or hospital mortality. The median follow-up time after transplant was 26 months

Discussion

In recent years, new strategies for the prophylaxis of hepatitis B after liver transplant have been proposed to avoid the inconvenience associated with long-term administration of HBIG. Due to the low genetic barrier, the use of LAM as monoprophylaxis has raised concerns regarding the potential risk of virologic breakthrough with the emergence of drug-resistant mutations. The availability of newer and more potent oral nucleoside/nucleotide analogues with higher genetic barriers and with

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Conflicts of interest The authors disclose the following: Man-Fung Yuen has received speakers' bureau and research grants from Bristol-Myers Squibb. Ching-Lung Lai and James Fung have been invited speakers for Bristol-Myers Squibb. The remaining authors disclose no conflicts.

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