Hepatitis B Prophylaxis after Liver Transplantation in Korea: Analysis of the KOTRY Database
- Author:
Gil Chun PARK
1
;
Shin HWANG
;
Myoung Soo KIM
;
Dong Hwan JUNG
;
Gi Won SONG
;
Kwang Woong LEE
;
Jong Man KIM
;
Jae Geun LEE
;
Je Ho RYU
;
Dong Lak CHOI
;
Hee Jung WANG
;
Bong Wan KIM
;
Dong Sik KIM
;
Yang Won NAH
;
Young Kyoung YOU
;
Koo Jeong KANG
;
Hee Chul YU
;
Yo Han PARK
;
Kyung Jin LEE
;
Yun Kyu KIM
Author Information
- Publication Type:Original Article
- Keywords: Hepatitis B Virus; Recurrence; Liver Transplantation; Hepatitis B Immunoglobulin; Antiviral Agent
- MeSH: Antiviral Agents; Carcinoma, Hepatocellular; Cohort Studies; DNA; Follow-Up Studies; Half-Life; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis B; Hepatitis; Humans; Immunoglobulins; Korea; Liver Transplantation; Liver; Organ Transplantation; Polymerase Chain Reaction; Recurrence; Transplants
- From:Journal of Korean Medical Science 2020;35(6):36-
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.CONCLUSION: Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.
