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

Affiliations
  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
  • 2Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 6Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.
  • 7Department of Surgery, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea.
  • 8Department of Surgery, Korean University Anam Hospital, Korean University College of Medicine, Seoul, Korea.
  • 9Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
  • 10Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 11Department of Surgery, Keimyung University School of Medicine, Daegu, Korea.
  • 12Department of Surgery, Jeonbuk National University Hospital, Jeonbuk National University College of Medicine, Jeonju, Korea.
  • 13Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 14Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

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
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