1. Oral Nucleos(t)ide Analogs Alone After Liver Transplantation in Chronic Hepatitis B With Preexisting rt204 Mutation.
- Author
-
Fung J, Wong T, Chok K, Chan A, Sin SL, Cheung TT, Dai WC, Ng K, Ng K, Man K, Seto WK, Lai CL, Yuen MF, and Lo CM
- Subjects
- Administration, Oral, Adult, Aged, Antiviral Agents adverse effects, DNA, Viral genetics, Drug Administration Schedule, End Stage Liver Disease diagnosis, End Stage Liver Disease mortality, End Stage Liver Disease virology, Female, Genotype, Graft Survival drug effects, Hepatitis B virus genetics, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic mortality, Hepatitis B, Chronic virology, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Nucleosides adverse effects, Nucleotides adverse effects, Recurrence, Risk Factors, Time Factors, Treatment Outcome, Viral Load, Virus Activation drug effects, Antiviral Agents administration & dosage, Drug Resistance, Viral genetics, End Stage Liver Disease surgery, Hepatitis B virus drug effects, Hepatitis B, Chronic drug therapy, Lamivudine administration & dosage, Liver Transplantation adverse effects, Liver Transplantation mortality, Mutation, Nucleosides administration & dosage, Nucleotides administration & dosage
- Abstract
Background: There is currently limited data regarding the use of oral antiviral therapy alone without hepatitis B immune globulin for chronic hepatitis B patients with preexisting lamivudine (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 chronic hepatitis B 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 hepatitis B surface antigen seroclearance at 1, 5, and 10 years was 82%, 88%, and 91%, respectively. At the time of transplantation, 39 (72%) patients had detectable hepatitis B virus (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 the patients had undetectable HBV DNA, and from 8 years onward, 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 hepatitis B immune globulin is highly effective in preventing HBV reactivation and graft loss from recurrent hepatitis B after liver transplantation in patients with preexisting LAM resistance HBV. The long-term outcome was excellent, with survival of 87% at 12 years after transplantation, without any mortality related to HBV reactivation.
- Published
- 2017
- Full Text
- View/download PDF