Antiviral prophylaxis with hepatitis B immunoglobulin (HBIg) plus lamivudine reduces the risk of hepatitis B virus (HBV) recurrence after HBV-related liver transplant (LT).However, HBIg is expensive, and lamivudine therapy is limited by drug resistance.This study assessed a pilot study of entecavir plus low-dose, on-demand HBIg in preventing HBV recurrence after LT.low-dose, on-demand HBIg in preventing HBV recurrence after LT. Between 2006 and May 2011, 145 patients undergoing HBV-related LT and receiving entecavir plus low-dose, on-demand HBIg were enrolled, and followed for a median of 36 months. A historical control group of 171 patients undergoing HBV-related LT between 1998 and 2010 and receiving lamivudine plus HBIg were followed for a median of 77 months. The primary endpoint was the proportion of patients with recurrent HBsAg-positivity, In the entecavir cohort, 2/145 (1.37%) patients experienced HBV recurrence, none of which had evidence of viral resistance. In the lamivudine cohort, 11/171 (6.4%) cases of HBV recurrence were observed,5 of which were associated with lamivudine resistance. The cumulative probabilities of HBV recurrence were different both cohorts with borderlinr significance (p=0.055). HBsAg recurrence was associated with lower overall survival (P<0.001), even in patients with undetectable HBV DNA. Using pooled data from both cohorts, predictors of HBV recurrence were nucleoside selection, pre-LT hepatocellular carcinoma, post-LT low anti-HBs, male gender, and HBsAg-positivity in the explant liver tissue. Conclusions: Entecavirplus low-dose, on-demand HBIg resulted in a low rate of HBV recurrence without evidence of resistancedevelopmet, and provided an effective and cost-saving strategy for patients having HBV related LT.
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