Prevention and treatment of new hepatitis B after living donor liver transplantation in children.

Abstract

BackgroundThis study aimed to explore the prevention and treatment of new hepatitis B in children after liver transplantation with livers positive for HBcAg and to examine the treatment of new hepatitis B.MethodsA total of 22 children who received livers positive for HBcAg between January 2013 and December 2015 were retrospectively analyzed. After their operations, the children were given lamivudine for anti-hepatitis B virus (HBV) treatment, a hepatitis B vaccine or intermittent supplements of hepatitis B immunoglobulins to prevent recurrence of the infection, and entecavir for anti-hepatitis B treatment. The children were categorized into two groups: one group of children stopped taking lamivudine one year after operation (n=7) by themselves, while the other group did not (n=15).ResultsOf the seven children who stopped lamivudine anti-HBV treatment, six developed hepatitis B at 24.33±13.95 months after operation. Of these children, five were treated with entecavir, resulting in their HBV DNA decreasing to undetectable levels (<50 IU/mL). HBsAg turned negative in four of these patients, but in one patient it did not. The other patient with new hepatitis B continued to use lamivudine, resulting in their HBV DNA decreasing to normal levels (<50 IU/mL) but without their HBsAg turning negative. No new cases of hepatitis B were found in the 15 children who did not stop anti-HBV treatment.ConclusionsThe long-term prophylactic therapy of nucleoside analogues combined with hepatitis B immunoglobulins should be used for a long time after liver transplantation with a liver positive for HBcAg. Discontinuation of nucleoside analogues is associated with a higher risk of the new onset of hepatitis B. Entecavir has a significant effect on the treatment of postoperative new hepatitis B in children.