Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious
Background Combination therapy with HBIG and NAs has reduced HBV recurrence post LT. Despite its efficacy, costs of HBIG remain prohibitive. With high-potency NAs, HBIG’s use has been questioned. We aim to evaluate the efficacy and safety of HBIG-free regimens in patients transplanted for HBV-relate...
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| Veröffentlicht in: | Hepatology international 2020, Vol.14 (1), p.57-69 |
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| creator | Muthiah, Mark D. Tan, En Ying Chua, Sin Hui Melissa Huang, Daniel Q. Y. Bonney, Glenn K. Kow, Alfred W. C. Lim, Seng Gee Dan, Yock Young Tan, Poh Seng Lee, Guan Huei Lim, Boon Leng |
| description | Background
Combination therapy with HBIG and NAs has reduced HBV recurrence post LT. Despite its efficacy, costs of HBIG remain prohibitive. With high-potency NAs, HBIG’s use has been questioned. We aim to evaluate the efficacy and safety of HBIG-free regimens in patients transplanted for HBV-related liver disease.
Methods
A review of LT patients at the National University Hospital, Singapore from 2001 to 2015 was performed. Patients transplanted for HBV were divided by antiviral treatment received: high- or low-potency NAs, or a combination of HBIG with high-potency NAs. Post-transplant outcomes were reviewed till data censure. Primary outcome was recurrence of HBV viremia post-transplant, while secondary outcomes were HBsAg sero-clearance, graft survival and mortality.
Results
Among 58 patients, 51 (88%) had persistent HBV viral suppression. Patients on a high-potency agent had significantly higher viral suppression compared to those on a low-potency agent (97% vs 72%,
p
= 0.02). This was also seen in patients with VL detectable at transplant (100% vs 50%,
p
|
| doi_str_mv | 10.1007/s12072-019-10011-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2336256725</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2349195779</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-3f91996a45542d3f4378c670f57bd2c783e8a336ddf3c8726eeaeff9f4e91ec93</originalsourceid><addsrcrecordid>eNp9kctOwzAQRS0EoqXwAyyQJTZsAn7EdrKEipdUwQbWkXHGYJTGwU4Q_XscCkViwcoezZk7V3MROqTklBKiziJlRLGM0DJLNaUZ20JTWnKZEZHT7c2f8wnai_GVECEklbtowmlJS6mKKWrvBtOAj64GrFvd-Ge89K3vXyDoboWtD7gLvntZNfrDRexafAOd7l2figvcuHcIuA-6jV2j2x6PLWj7BEYctR01awzWOqON80PcRztWNxEOvt8Zery6fJjfZIv769v5-SIzXIk-4zb5K6XOhchZzW3OVWGkIlaop5oZVXAoNOeyri03hWISQKctpc2hpGBKPkMna91k_m2A2FdLFw00ySQkGxVLw0xIxURCj_-gr34I6RQjlScfQqlRkK0pE3yMAWzVBbfUYVVRUo1pVOs0qpRG9ZVGmp6ho2_p4WkJ9Wbk5_wJ4Gsgplb7DOF39z-yn118ll0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2349195779</pqid></control><display><type>article</type><title>Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious</title><source>SpringerLink Journals</source><creator>Muthiah, Mark D. ; Tan, En Ying ; Chua, Sin Hui Melissa ; Huang, Daniel Q. Y. ; Bonney, Glenn K. ; Kow, Alfred W. C. ; Lim, Seng Gee ; Dan, Yock Young ; Tan, Poh Seng ; Lee, Guan Huei ; Lim, Boon Leng</creator><creatorcontrib>Muthiah, Mark D. ; Tan, En Ying ; Chua, Sin Hui Melissa ; Huang, Daniel Q. Y. ; Bonney, Glenn K. ; Kow, Alfred W. C. ; Lim, Seng Gee ; Dan, Yock Young ; Tan, Poh Seng ; Lee, Guan Huei ; Lim, Boon Leng</creatorcontrib><description>Background
Combination therapy with HBIG and NAs has reduced HBV recurrence post LT. Despite its efficacy, costs of HBIG remain prohibitive. With high-potency NAs, HBIG’s use has been questioned. We aim to evaluate the efficacy and safety of HBIG-free regimens in patients transplanted for HBV-related liver disease.
Methods
A review of LT patients at the National University Hospital, Singapore from 2001 to 2015 was performed. Patients transplanted for HBV were divided by antiviral treatment received: high- or low-potency NAs, or a combination of HBIG with high-potency NAs. Post-transplant outcomes were reviewed till data censure. Primary outcome was recurrence of HBV viremia post-transplant, while secondary outcomes were HBsAg sero-clearance, graft survival and mortality.
Results
Among 58 patients, 51 (88%) had persistent HBV viral suppression. Patients on a high-potency agent had significantly higher viral suppression compared to those on a low-potency agent (97% vs 72%,
p
= 0.02). This was also seen in patients with VL detectable at transplant (100% vs 50%,
p
< 0.01). None of the 16 patients with VL detectable at transplant and treated with high-potency agents developed recurrence. 42 patients (72%) achieved persistent HBsAg sero-clearance. Although this was higher in the high-potency NA-only group, it was not statistically significant (
p
= 0.56). There were no graft failures or mortalities attributed to HBV recurrence.
Conclusion
With the use of high-potency agents, HBIG may not be necessary in the treatment of patients transplanted for HBV-related liver disease, even in the presence of detectable VL at time of transplant.</description><identifier>ISSN: 1936-0533</identifier><identifier>EISSN: 1936-0541</identifier><identifier>DOI: 10.1007/s12072-019-10011-2</identifier><identifier>PMID: 31919678</identifier><language>eng</language><publisher>New Delhi: Springer India</publisher><subject>Antiretroviral drugs ; Antiviral drugs ; Colorectal Surgery ; Hepatitis ; Hepatitis B ; Hepatitis B surface antigen ; Hepatology ; Liver ; Liver diseases ; Liver transplantation ; Liver transplants ; Medical treatment ; Medicine ; Medicine & Public Health ; Nucleoside analogs ; Original Article ; Patients ; Prophylaxis ; Statistical analysis ; Surgery ; Viremia</subject><ispartof>Hepatology international, 2020, Vol.14 (1), p.57-69</ispartof><rights>Asian Pacific Association for the Study of the Liver 2020</rights><rights>2020© Asian Pacific Association for the Study of the Liver 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-3f91996a45542d3f4378c670f57bd2c783e8a336ddf3c8726eeaeff9f4e91ec93</citedby><cites>FETCH-LOGICAL-c375t-3f91996a45542d3f4378c670f57bd2c783e8a336ddf3c8726eeaeff9f4e91ec93</cites><orcidid>0000-0002-8652-6403</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12072-019-10011-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12072-019-10011-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31919678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muthiah, Mark D.</creatorcontrib><creatorcontrib>Tan, En Ying</creatorcontrib><creatorcontrib>Chua, Sin Hui Melissa</creatorcontrib><creatorcontrib>Huang, Daniel Q. Y.</creatorcontrib><creatorcontrib>Bonney, Glenn K.</creatorcontrib><creatorcontrib>Kow, Alfred W. C.</creatorcontrib><creatorcontrib>Lim, Seng Gee</creatorcontrib><creatorcontrib>Dan, Yock Young</creatorcontrib><creatorcontrib>Tan, Poh Seng</creatorcontrib><creatorcontrib>Lee, Guan Huei</creatorcontrib><creatorcontrib>Lim, Boon Leng</creatorcontrib><title>Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious</title><title>Hepatology international</title><addtitle>Hepatol Int</addtitle><addtitle>Hepatol Int</addtitle><description>Background
Combination therapy with HBIG and NAs has reduced HBV recurrence post LT. Despite its efficacy, costs of HBIG remain prohibitive. With high-potency NAs, HBIG’s use has been questioned. We aim to evaluate the efficacy and safety of HBIG-free regimens in patients transplanted for HBV-related liver disease.
Methods
A review of LT patients at the National University Hospital, Singapore from 2001 to 2015 was performed. Patients transplanted for HBV were divided by antiviral treatment received: high- or low-potency NAs, or a combination of HBIG with high-potency NAs. Post-transplant outcomes were reviewed till data censure. Primary outcome was recurrence of HBV viremia post-transplant, while secondary outcomes were HBsAg sero-clearance, graft survival and mortality.
Results
Among 58 patients, 51 (88%) had persistent HBV viral suppression. Patients on a high-potency agent had significantly higher viral suppression compared to those on a low-potency agent (97% vs 72%,
p
= 0.02). This was also seen in patients with VL detectable at transplant (100% vs 50%,
p
< 0.01). None of the 16 patients with VL detectable at transplant and treated with high-potency agents developed recurrence. 42 patients (72%) achieved persistent HBsAg sero-clearance. Although this was higher in the high-potency NA-only group, it was not statistically significant (
p
= 0.56). There were no graft failures or mortalities attributed to HBV recurrence.
Conclusion
With the use of high-potency agents, HBIG may not be necessary in the treatment of patients transplanted for HBV-related liver disease, even in the presence of detectable VL at time of transplant.</description><subject>Antiretroviral drugs</subject><subject>Antiviral drugs</subject><subject>Colorectal Surgery</subject><subject>Hepatitis</subject><subject>Hepatitis B</subject><subject>Hepatitis B surface antigen</subject><subject>Hepatology</subject><subject>Liver</subject><subject>Liver diseases</subject><subject>Liver transplantation</subject><subject>Liver transplants</subject><subject>Medical treatment</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nucleoside analogs</subject><subject>Original Article</subject><subject>Patients</subject><subject>Prophylaxis</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Viremia</subject><issn>1936-0533</issn><issn>1936-0541</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kctOwzAQRS0EoqXwAyyQJTZsAn7EdrKEipdUwQbWkXHGYJTGwU4Q_XscCkViwcoezZk7V3MROqTklBKiziJlRLGM0DJLNaUZ20JTWnKZEZHT7c2f8wnai_GVECEklbtowmlJS6mKKWrvBtOAj64GrFvd-Ge89K3vXyDoboWtD7gLvntZNfrDRexafAOd7l2figvcuHcIuA-6jV2j2x6PLWj7BEYctR01awzWOqON80PcRztWNxEOvt8Zery6fJjfZIv769v5-SIzXIk-4zb5K6XOhchZzW3OVWGkIlaop5oZVXAoNOeyri03hWISQKctpc2hpGBKPkMna91k_m2A2FdLFw00ySQkGxVLw0xIxURCj_-gr34I6RQjlScfQqlRkK0pE3yMAWzVBbfUYVVRUo1pVOs0qpRG9ZVGmp6ho2_p4WkJ9Wbk5_wJ4Gsgplb7DOF39z-yn118ll0</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Muthiah, Mark D.</creator><creator>Tan, En Ying</creator><creator>Chua, Sin Hui Melissa</creator><creator>Huang, Daniel Q. Y.</creator><creator>Bonney, Glenn K.</creator><creator>Kow, Alfred W. C.</creator><creator>Lim, Seng Gee</creator><creator>Dan, Yock Young</creator><creator>Tan, Poh Seng</creator><creator>Lee, Guan Huei</creator><creator>Lim, Boon Leng</creator><general>Springer India</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8652-6403</orcidid></search><sort><creationdate>2020</creationdate><title>Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious</title><author>Muthiah, Mark D. ; Tan, En Ying ; Chua, Sin Hui Melissa ; Huang, Daniel Q. Y. ; Bonney, Glenn K. ; Kow, Alfred W. C. ; Lim, Seng Gee ; Dan, Yock Young ; Tan, Poh Seng ; Lee, Guan Huei ; Lim, Boon Leng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-3f91996a45542d3f4378c670f57bd2c783e8a336ddf3c8726eeaeff9f4e91ec93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antiretroviral drugs</topic><topic>Antiviral drugs</topic><topic>Colorectal Surgery</topic><topic>Hepatitis</topic><topic>Hepatitis B</topic><topic>Hepatitis B surface antigen</topic><topic>Hepatology</topic><topic>Liver</topic><topic>Liver diseases</topic><topic>Liver transplantation</topic><topic>Liver transplants</topic><topic>Medical treatment</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nucleoside analogs</topic><topic>Original Article</topic><topic>Patients</topic><topic>Prophylaxis</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Viremia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Muthiah, Mark D.</creatorcontrib><creatorcontrib>Tan, En Ying</creatorcontrib><creatorcontrib>Chua, Sin Hui Melissa</creatorcontrib><creatorcontrib>Huang, Daniel Q. Y.</creatorcontrib><creatorcontrib>Bonney, Glenn K.</creatorcontrib><creatorcontrib>Kow, Alfred W. C.</creatorcontrib><creatorcontrib>Lim, Seng Gee</creatorcontrib><creatorcontrib>Dan, Yock Young</creatorcontrib><creatorcontrib>Tan, Poh Seng</creatorcontrib><creatorcontrib>Lee, Guan Huei</creatorcontrib><creatorcontrib>Lim, Boon Leng</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Muthiah, Mark D.</au><au>Tan, En Ying</au><au>Chua, Sin Hui Melissa</au><au>Huang, Daniel Q. Y.</au><au>Bonney, Glenn K.</au><au>Kow, Alfred W. C.</au><au>Lim, Seng Gee</au><au>Dan, Yock Young</au><au>Tan, Poh Seng</au><au>Lee, Guan Huei</au><au>Lim, Boon Leng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious</atitle><jtitle>Hepatology international</jtitle><stitle>Hepatol Int</stitle><addtitle>Hepatol Int</addtitle><date>2020</date><risdate>2020</risdate><volume>14</volume><issue>1</issue><spage>57</spage><epage>69</epage><pages>57-69</pages><issn>1936-0533</issn><eissn>1936-0541</eissn><abstract>Background
Combination therapy with HBIG and NAs has reduced HBV recurrence post LT. Despite its efficacy, costs of HBIG remain prohibitive. With high-potency NAs, HBIG’s use has been questioned. We aim to evaluate the efficacy and safety of HBIG-free regimens in patients transplanted for HBV-related liver disease.
Methods
A review of LT patients at the National University Hospital, Singapore from 2001 to 2015 was performed. Patients transplanted for HBV were divided by antiviral treatment received: high- or low-potency NAs, or a combination of HBIG with high-potency NAs. Post-transplant outcomes were reviewed till data censure. Primary outcome was recurrence of HBV viremia post-transplant, while secondary outcomes were HBsAg sero-clearance, graft survival and mortality.
Results
Among 58 patients, 51 (88%) had persistent HBV viral suppression. Patients on a high-potency agent had significantly higher viral suppression compared to those on a low-potency agent (97% vs 72%,
p
= 0.02). This was also seen in patients with VL detectable at transplant (100% vs 50%,
p
< 0.01). None of the 16 patients with VL detectable at transplant and treated with high-potency agents developed recurrence. 42 patients (72%) achieved persistent HBsAg sero-clearance. Although this was higher in the high-potency NA-only group, it was not statistically significant (
p
= 0.56). There were no graft failures or mortalities attributed to HBV recurrence.
Conclusion
With the use of high-potency agents, HBIG may not be necessary in the treatment of patients transplanted for HBV-related liver disease, even in the presence of detectable VL at time of transplant.</abstract><cop>New Delhi</cop><pub>Springer India</pub><pmid>31919678</pmid><doi>10.1007/s12072-019-10011-2</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-8652-6403</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1936-0533 |
| ispartof | Hepatology international, 2020, Vol.14 (1), p.57-69 |
| issn | 1936-0533 1936-0541 |
| language | eng |
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| source | SpringerLink Journals |
| subjects | Antiretroviral drugs Antiviral drugs Colorectal Surgery Hepatitis Hepatitis B Hepatitis B surface antigen Hepatology Liver Liver diseases Liver transplantation Liver transplants Medical treatment Medicine Medicine & Public Health Nucleoside analogs Original Article Patients Prophylaxis Statistical analysis Surgery Viremia |
| title | Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious |
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