Abstract
Background & AimsApplication of nucleoside analogues and hepatitis B immunoglobulin (HBIG) has reduced hepatitis B virus (HBV) recurrence rate after liver transplantation (LT) dramatically. Recent data suggests therapy without HBIG is also effective. We sought to evaluate the necessity of HBIG in prophylaxis of HBV recurrence after LT.MethodsA meta-analysis was performed. PubMed/MEDLINE, Web of Knowledge and other databases were searched for eligible literatures. The major end points were recurrence rate, patient survival, and YMDD mutant. Risk difference (RD) or risk ratio (RR) was calculated to synthesize the results.ResultsNineteen studies with a total of 1484 patients were included in this analysis. Application of HBIG was helpful to reduce HBV recurrence [P<0.001; RD = 0.16; 95% confidence interval (CI)(0.12, 0.20)] and virus mutants [P<0.001; RR = 3.13; 95%CI (1.86–5.26)], it also improved patients' 1-year [P = 0.03; RD = 0.08; 95%CI (0.01, 0.15)] and 3-year survival rates [P = 0.005; RD = 0.17; 95%CI(0.05, 0.28)]. No significant difference was found for patients' 5-year survival [P = 0.46; RD = −0.06; 95%CI (−0.21, 0.10)]. Sub-group analysis showed that in patients with positive pre-operative HBV DNA status, HBIG was necessary to reduce HBV recurrence rate (P<0.001; RD = 0.42; 95%CI (0.32, 0.52)). In patients with negative HBV DNA, combined therapy gained no significant advantages (P = 0.18; RD = 0.06; 95%CI (−0.03, 0.14)). Non-Lamivudine (non-LAM) antiviral drugs performed as well as combination therapy in prophylaxis of HBV recurrence after LT (P = 0.37; RD = 0.06; 95%CI (−0.02, 0.14)).ConclusionsHBIG with nucleoside analogues is helpful to reduce HBV recurrence and virus mutants. The necessity of HBIG in prophylaxis of HBV recurrence after LT when using new potent nucleoside analogues, especially for patients with negative pre-transplant HBV DNA status remains to be evaluated.
Highlights
Over 400 million people have been infected with chronic hepatitis B virus (HBV) worldwide, with two-thirds of them in Asia [1]
Application of hepatitis B immunoglobulin (HBIG) was helpful to reduce HBV recurrence [P,0.001; Risk difference (RD) = 0.16; 95% confidence interval (CI)(0.12, 0.20)] and virus mutants [P,0.001; risk ratio (RR) = 3.13; 95%CI (1.86–5.26)], it improved patients’ 1-year [P = 0.03; RD = 0.08; 95%CI (0.01, 0.15)] and 3-year survival rates [P = 0.005; RD = 0.17; 95%CI(0.05, 0.28)]
The combination of antiviral drugs and HBIG significantly reduced HBV recurrence rate and YMDD mutants; this strategy is widely accepted as a routine prophylaxis for HBV recurrence after liver transplantation (LT) [11,12,13,14]
Summary
Over 400 million people have been infected with chronic hepatitis B virus (HBV) worldwide, with two-thirds of them in Asia [1]. The application of the first nucleoside analogue, lamivudine (LAM), reduced the recurrence rate of hepatitis B virus after LT dramatically. Its long-term use was associated with the risk of YMDD mutants, which would lead to the failure of hepatitis prevention, and possibly even the loss of the graft and the death of the recipient [7,8,9]. Hepatitis B immunoglobulin (HBIG) is efficient as a passive immune agent against HBV. The combination of antiviral drugs and HBIG significantly reduced HBV recurrence rate and YMDD mutants; this strategy is widely accepted as a routine prophylaxis for HBV recurrence after LT [11,12,13,14]. Application of nucleoside analogues and hepatitis B immunoglobulin (HBIG) has reduced hepatitis B virus (HBV) recurrence rate after liver transplantation (LT) dramatically. We sought to evaluate the necessity of HBIG in prophylaxis of HBV recurrence after LT
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