J Korean Med Sci.  2020 Feb;35(6):e36. 10.3346/jkms.2020.35.e36.

Hepatitis B Prophylaxis after Liver Transplantation in Korea: Analysis of the KOTRY Database

• Park GC
• Hwang S
• Kim MS
• Jung DH
• Song GW
• Lee KW
• Kim JM
• Lee JG
• Ryu JH
• Choi DL
• Wang HJ
• Kim BW
• Kim DS
• Nah YW
• You YK
• Kang KJ
• Yu HC
• Park YH
• Lee KJ
• Kim YK

• KMID: 2469941
• DOI: http://doi.org/10.3346/jkms.2020.35.e36

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.

Keyword

Hepatitis B Virus; Recurrence; Liver Transplantation; Hepatitis B Immunoglobulin; Antiviral Agent

MeSH Terms

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
Antiviral Agents
DNA
Hepatitis B Surface Antigens
Immunoglobulins