Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients: A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal

Matteo A. Manini; Gavin Whitehouse; Matthew Bruce; Matteo Passerini; Tiong Y. Lim; Ivana Carey; Aisling Considine; Pietro Lampertico; Abid Suddle; Nigel Heaton; Michael Heneghan; Kosh Agarwal

doi:10.1016/j.dld.2018.03.032

Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients: A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal

Matteo A. Manini, Gavin Whitehouse, Matthew Bruce, Matteo Passerini, Tiong Y. Lim, Ivana Carey, Aisling Considine, Pietro Lampertico, Abid Suddle, Nigel Heaton, Michael Heneghan, Kosh Agarwal

King's College London

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Abstract

BackgroundRecent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT).
Patients and Methods Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy.
Results Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Group A and B patients were followed for 69 (range 13-83) months and 61 (range 31-78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1-40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence.
Conclusion HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.

Original language	English
Journal	DIGESTIVE AND LIVER DISEASE
Early online date	13 Apr 2018
DOIs	https://doi.org/10.1016/j.dld.2018.03.032
Publication status	E-pub ahead of print - 13 Apr 2018

Keywords

Hepatocellular carcinoma
HBsAg titre
HBV DNA level
antiviral drug-resistance mutation
safety

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.dld.2018.03.032

Entecavir Or Tenofovir Monotherapy_MANINI_Accepted26March2018_GREEN AAM (CC BY-NC-ND)
© <2018> This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode
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Manini, M. A., Whitehouse, G., Bruce, M., Passerini, M., Lim, T. Y., Carey, I., Considine, A., Lampertico, P., Suddle, A., Heaton, N., Heneghan, M., & Agarwal, K. (2018). Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients: A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal. DIGESTIVE AND LIVER DISEASE. Advance online publication. https://doi.org/10.1016/j.dld.2018.03.032

@article{eb9dfb1bb5fc4338a450ea2fdcf1d342,

title = "Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients: A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal",

abstract = "BackgroundRecent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT).Patients and Methods Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. Results Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Group A and B patients were followed for 69 (range 13-83) months and 61 (range 31-78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1-40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. Conclusion HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.",

keywords = "Hepatocellular carcinoma, HBsAg titre, HBV DNA level, antiviral drug-resistance mutation, safety",

author = "Manini, {Matteo A.} and Gavin Whitehouse and Matthew Bruce and Matteo Passerini and Lim, {Tiong Y.} and Ivana Carey and Aisling Considine and Pietro Lampertico and Abid Suddle and Nigel Heaton and Michael Heneghan and Kosh Agarwal",

year = "2018",

month = apr,

day = "13",

doi = "10.1016/j.dld.2018.03.032",

language = "English",

journal = "DIGESTIVE AND LIVER DISEASE",

issn = "1590-8658",

publisher = "Elsevier",

}

Manini, MA, Whitehouse, G, Bruce, M, Passerini, M, Lim, TY , Carey, I, Considine, A, Lampertico, P, Suddle, A, Heaton, N , Heneghan, M & Agarwal, K 2018, 'Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients: A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal', DIGESTIVE AND LIVER DISEASE. https://doi.org/10.1016/j.dld.2018.03.032

TY - JOUR

T1 - Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients

T2 - A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal

AU - Manini, Matteo A.

AU - Whitehouse, Gavin

AU - Bruce, Matthew

AU - Passerini, Matteo

AU - Lim, Tiong Y.

AU - Carey, Ivana

AU - Considine, Aisling

AU - Lampertico, Pietro

AU - Suddle, Abid

AU - Heaton, Nigel

AU - Heneghan, Michael

AU - Agarwal, Kosh

PY - 2018/4/13

Y1 - 2018/4/13

N2 - BackgroundRecent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT).Patients and Methods Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. Results Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Group A and B patients were followed for 69 (range 13-83) months and 61 (range 31-78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1-40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. Conclusion HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.

AB - BackgroundRecent data suggest that oral third-generation nucleos(t)ide analogs (NA) monoprophylaxis following hepatitis B immunoglobulin (HBIg) withdrawal may be effective to prevent HBV reinfection after liver transplantation (LT).Patients and Methods Between 01/2010 and 03/2012, all HBV monoinfected and HBV/HDV co-infected LT patients followed in our centre withdrew HBIg ± NA and were commenced on either ETV or TDF as monotherapy. Results Seventy-seven patients were included in the study (55% TDF, 45% ETV). Group A comprised 69 HBV monoinfected patients and Group B 8 HBV/HDV co-infected patients. After HBIg withdrawal, Group A and B patients were followed for 69 (range 13-83) months and 61 (range 31-78) months, respectively. No Group B patients had HBsAg or HBV DNA recurrence, while 6 (9%) Group A patients became HBsAg-positive after a median of 18 (range 1-40) months. The cumulative 5-year incidence of HBsAg recurrence was 9%. All 6 patients demonstrated undetectable HBV-DNA levels and stable graft function during 30 months of additional follow-up. In 3/6 patients, seroconversion was transitory, while the remaining 3 showed HBsAg levels <0.13 IU/mL over the entire period of observation. Pre-LT HCC emerged as the strongest predictor of HBsAg recurrence. Conclusion HBIG can be safely discontinued in HBsAgpositive LT recipients and replaced by ETV or TDF monotherapy.

KW - Hepatocellular carcinoma

KW - HBsAg titre

KW - HBV DNA level

KW - antiviral drug-resistance mutation

KW - safety

U2 - 10.1016/j.dld.2018.03.032

DO - 10.1016/j.dld.2018.03.032

M3 - Article

SN - 1590-8658

JO - DIGESTIVE AND LIVER DISEASE

JF - DIGESTIVE AND LIVER DISEASE

ER -

Entecavir Or Tenofovir Monotherapy Prevents HBV Recurrence In Liver Transplant Recipients: A 5-Year Follow-Up Study After Hepatitis B Immunoglobulin Withdrawal

Abstract

Keywords

UN SDGs

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