Oral nucleos(t)ide Analogs Alone After Liver Transplantation in Chronic Hepatitis B with Preexisting rt204 Mutation

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Abstract

Background

There is currently limited data regarding the use of oral antiviral therapy alone without HBIG for CHB patients with preexisting LAM-resistance (LAM-R) undergoing liver transplantation.

Methods

This is a cohort study determining the effectiveness and long-term outcome in this group of patients.

Results

Fifty-seven consecutive CHB patients with preexisting rt204 LAM-R mutations or virological load refractory to LAM undergoing liver transplantation were included, with a median follow-up of 73 months. Fifty-five (96.5%) patients received a regimen that included the use of nucleotide analogs. The cumulative rate of HBsAg seroclearance at 1, 5, and 10 years was 82%, 88%, and 91% respectively. At the time of transplantation, 39 (72%) patients had detectable HBV DNA, with a median of 4.5 log copies/mL. The cumulative rate of HBV undetectability was 91% at 1 year, increasing to 100% by 5 years. After 1 year of liver transplantation, over 90% of patients had undetectable HBV DNA, and from 8 years onwards, 100% had undetectable HBV DNA. The overall long-term survival was excellent, with a 12-year survival of 87%. There was no HBV-related graft loss, and no retransplantation or deaths due to HBV reactivation.

Conclusion

Oral antiviral therapy alone without HBIG is highly effective in preventing HBV reactivation and graft loss from recurrent hepatitis B after liver transplantation in patients with preexisting lamivudine resistance HBV. The long-term outcome was excellent, with survival of 87% at 12 years after transplantation, without any mortality related to HBV reactivation.

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