Korean J Transplant.  2022 Nov;36(Supple 1):S21. 10.4285/ATW2022.F-1089.

The role of passive hepatitis b virus immunization in hepatitis d virus reactivation in liver transplant patients

• Ganbold A
• Bayarsaikhan S
• Chimedtseren M
• Norov O
• Ochirkhuree B

• KMID: 2535169
• DOI: http://doi.org/10.4285/ATW2022.F-1089

Abstract

Background
The advent of high-efficacy nucleos(t)ide analogues (NA) have cast doubt on the utility of the hepatitis B virus (HBV) passive immunization (HBIg) in a post-liver transplant setting. However, the literature on the role of the HBIg in protec-tion from hepatitis D virus (HDV)-reactivation remains contradictory. In this study, we randomly compare for current HDV-repli-cation in those who have received HBIg and in those who have not in our HBV+HDV related post-liver transplant population.
Methods
We invited 89 adults who prior to transplantation were HBV or HBV+HDV, and who were at least 1-year posttransplanta-tion on January 1, 2021 (1–9 years follow-up). Fifty-seven patients (34/23 males/females; average age, 50.3 years) accepted: 23 in HBIg and 34 in non-HBIg group. The HBsAg, Anti-HDV, HBV-DNA and HDV-RNA were analyzed between March and December 2021. Non-HBV/HDV causes were excluded. Individual interviews were conducted with each patient on NA-regimen compliance and pre-op HBV/HDV status. The GPT and GOT were tested in replication-positive patients.
Results
The HDV-RNA, HBV-DNA, HBsAg and Anti-HDV positivity in the HBIg-group (n=23) was one (4.3%), four (17.4%), two (8.7%) and 22 (95.6%) patients respectively, in the non-HBIg-group (n=34) the same was two (5.9%), three (8.8%), four (11.8%) and 33 (97.05%) patients respectively. Upon interview, all reactivations were in patients who were non-compliant with their NA-regiment. Of the 13 patients who were said to be HBV or HBV/HCV co-infected prior to the transplantation, all but two ex-hibited Anti-HDV positivity.
Conclusions
We could not detect any HDV replication in the two study groups that was attributable to a spontaneous reactiva-tion while being compliant to their NA-regimen. The NAs seem to be effective in maintaining suppression of HDV replication. Adherence to the NA-regimen is more important than the HBIg in the liver transplantation setting. The vast majority of HDV re-crudescence cases were mild and were self-limiting after 1–2 years.