PROPHYLAXIS AGAINST DENOVO HEPATITIS B FOR LIVER TRANSPLANTATION UTILIZING HEP B CORE (+) DONORS: DOES HBIG PROVIDE A SURVIVAL ADVANTAGE?

摘要

Donor liver allografts with positive serology for Hepatitis B core antibody (HBc (+)) have been increasingly used for liver transplantation. However the optimal prophylactic regimen to prevent development of denovo hepatitis B has not been determined. To evaluate this, we screened UNOS STAR registry data for adult recipients of HBc (+) organs who were HBsAg (-), and evaluated the effects of using prophylactic anti-viral therapies (HBIG and Lamivudine) on patient and graft survival. Out of a total cohort of 958 patients transplanted since 2004, 61 received HBIG alone, 116 received Lamivudine alone, 66 both, 509 neither and 206 were missing this information. Based on several multivariable Cox regression models, patients receiving HBIG therapy-only were observed to have a statistically significant (~70%) reduction in risk of mortality compared to patients receiving Lamivudine-only therapy (HR = 0.29, 95% CI (0.10, 0.86), p=0.026), and a non-statistically significant reduction in risk of graft failure. However, no graft failures were attributed to denovo hepatitis B, suggesting that any improved graft/patient survival possibly associated with HBIG therapy occurs independently of denovo HBV reduction. While this study cannot prove that HBIG therapy is protective for graft and patient survival after liver transplantation, these findings do highlight the need to further examine and study prophylactic use in recipients of HBc (+) donors.