This study compares the clinical characteristics and functional cure rates of de novo (DNH) versus recurrent hepatitis B virus (HBV) infections following liver transplantation. Data from 150 adult patients diagnosed with post-transplant HBV between 2010 and 2024 were analyzed, explicitly excluding individuals receiving anti-HBc-positive donor grafts. Participants were stratified by pre-transplant serology into DNH (n = 36) and recurrent HBV (n = 114) cohorts. Clinically, the DNH group experienced more severe acute hepatic injury upon infection, evidenced by elevated median peak bilirubin levels and a remarkably higher incidence of hepatitis B e antigen (HBeAg) positivity at initial diagnosis (86.1% vs. 9.6%, p < 0.001). Despite this severe acute presentation, DNH patients exhibited robust hepatic recovery following antiviral intervention, achieving alanine aminotransferase (ALT) normalization rates comparable to the recurrent group (50.0% vs. 48.2%, p = 1.000). Functional cure, explicitly defined as sustained hepatitis B surface antigen (HBsAg) loss, was achieved in 20.67% (31/150) of the total cohort. Time-to-event Kaplan-Meier survival analysis demonstrated that the recurrent cohort achieved functional cure significantly earlier and at a higher cumulative probability (Log-rank p = 0.037). Crucially, multivariate Cox proportional hazards regression established that combination therapy with hepatitis B immunoglobulin (HBIG) served as a robust independent predictor of definitive functional cure (Adjusted Hazard Ratio = 4.21, p = 0.002), successfully overcoming initial baseline disparities. In conclusion, while DNH manifests as a severe acute infection due to pre-transplant immune naivety, recurrent HBV is associated with a more favorable trajectory toward functional cure. These findings support the implementation of personalized antiviral management, establishing that integrating nucleos(t)ide analogs with low-dose HBIG significantly optimizes definitive serological outcomes.

Hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues (NA) are standard prophylaxis against hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, indefinite HBIG use, with variations in dosage and duration across LT centres, has recently been questioned. This study reviewed current HBV management practices and outcomes after LT across the UK. We conducted a retrospective study of all HBV-related LTs in the UK (2010-2023) to review post-LT HBV prophylaxis, assess the impact of HBIG duration on HBV recurrence and overall survival and compare HBIG costs across protocols. Significant variation in protocols among LT centres was observed. The majority of the 273 patients were high risk for HBV recurrence (81.7%). After LT, 85% received HBIG regardless of the risk for HBV recurrence and 54.6% of patients continued HBIG treatment with a median duration of 119 days (IQR 10-344). A total of 14 patients (5.1%) experienced HBV recurrence within 12 months following LT. Our multivariate analysis indicated that triple immunosuppression following LT had a significantly increased risk of HBV recurrence. Survival rates at 1, 5 and 7 years after LT were 98.2%, 88.3% and 80.6%, respectively. In the Cox regression analysis, only lower HBIG IV doses during the first week after LT were associated with 7-year mortality. There is a vast discrepancy in HBIG usage across the UK. HBIG doses after LT and the risk of HBV recurrence groups do not influence outcomes. HBIG maintenance-free prophylaxis is therefore a feasible and cost-effective option for most patients. Further prospective studies should verify these findings and support wider adoption of HBIG-free strategies.

ABSTRACT To further reduce mother-to-child transmission (MTCT), this study aims to explore the factors influencing MTCT rate in pregnant women with extremely high HBV DNA loads (HBV DNA ≥ 1 × 107 IU/ml). In this retrospective real-world study, pregnant women with chronic hepatitis B virus (HBV) infection and their infants were analyzed. Pregnant women received antiviral therapy during the second or third trimester based on their HBV DNA loads and personal preferences. Newborns were administered hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine within 6 h after birth, while their HBV infection status was followed up after 7 months. Data from 4,157 pregnant women and 4192 infants were collected. All 35 cases of MTCT occurred in mothers with extremely high HBV DNA loads (1570 mothers and 1588 infants), of which 29 cases were in nonantiviral therapy group, and 6 in antiviral therapy group. Antiviral treatment could markedly reduce MTCT rate (p < 0.001). The decrease of HBV DNA loads below 1 × 105 IU/ml or above didn’t impact MTCT rate after antiviral treatment. The average initiating antiviral treatment time among mothers with MTCT was significantly later than mothers without MTCT (p = 0.008). In the absence of antiviral treatment, predelivery HBV DNA levels in mothers with MTCT were higher compared to those without MTCT (p = 0.001). MTCT mainly occurred in pregnant women with extremely high HBV DNA loads; however, antiviral treatment could reduce MTCT rate. The efficacy of antiviral drugs did not affect the incidence of MTCT, but early initiation of antiviral treatment may contribute to a decrease in its occurrence.

ABSTRACTUniversal infant hepatitis B (HBV) vaccination is highly effective in preventing infection. However, little is known about whether a mother's HBV vaccination history influences her child's immune response to routine immunisation. We aimed to compare vaccine‐induced antibody responses in children of vaccinated and unvaccinated mothers. We conducted a historical‐retrospective cohort study of 364 children who completed the standard infant HBV vaccination series and underwent post‐vaccination antibody testing. Maternal vaccination status was determined by serology, medical records and cohort year. Children were classified as offspring of HBsAg‐negative vaccinated mothers (n = 92), HBsAg‐negative unvaccinated mothers (n = 174), or HBsAg‐positive mothers (n = 98), who also received hepatitis B immunoglobulin (HBIG) at birth. Anti‐HBs titers were analysed and categorised. Ordinal logistic regression was used to assess associations. Overall seroprotection rates (≥ 10 mIU/mL) were high (89.3%) and did not differ significantly between groups. However, children born to mothers vaccinated prior to pregnancy were significantly more likely to achieve very high antibody levels (≥ 1000 mIU/mL) compared with children of unvaccinated mothers or those who received HBIG at birth (p < 0.05). This association was most pronounced in children tested at ≤ 3 years of age. Mean anti‐HBs titers were also highest in offspring of vaccinated mothers. While older maternal age and lower haemoglobin levels impaired the response, the HBIG did nothing. While infant HBV seroprotection rates were uniformly high regardless of maternal background, children born to mothers vaccinated against HBV prior to pregnancy exhibited a more robust early antibody response (≥ 1000 mIU/mL). These findings suggest a possible intergenerational enhancement of vaccine responsiveness and may affect long‐term implications for HBV vaccination strategies.

The combination of hepatitis B immunoglobulin (HBIG) and high-barrier nucleos(t)ide analogues (hbNUCs) is widely considered the standard of care for preventing hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, clinical practices in Italy remains heterogenous, particularly regarding HBIG dosage, administration intervals, formulation choice, and selection of patients eligible for hbNUCs monotherapy or short-course HBIG regimens. This modified Delphi panel aimed to characterize current Italian practices for HBV prophylaxis after LT, focusing on patient risk stratification and HBIG management. Sixteen Italian experts from EPAteam network participated in the three-round modified Delphi panel. After defining key clinical questions, a 35-item online survey was conducted. Any item with <66% agreement was designed as "controversial." Survey results and controversial topics were reviewed in a final in-person consensus meeting. All the sixteen panelists completed each Delphi round. There was agreement that the combination of hbNUCs and HBIG constitutes the standard HBV prophylaxis after LT. Patients with HBV-DNA >20,000IU/mL at LT and those with hepatitis D virus (HDV) coinfection were identified as high-risk for HBV recurrence and deemed candidates for life-long HBIG. No consensus was achieved on the optimal duration of prophylaxis for low-risk patients, nor on specific HBIG dosage and administration intervals for either risk group. Subcutaneous formulation was preferred for older patients without caregivers, frequent travelers, and those with coagulopathy. This modified Delphi panel confirmed that life-long combination of HBIG and NUCs remains the gold standard for the HBV prophylaxis after LT. Significant variability persists in clinical practice. Prophylactic strategies, especially in low-risk patients, are largely determined on a case-by-case basis, guided by patient characteristics rather than standardized protocols.

Mother-to-child transmission (MTCT) is a primary source of hepatitis B virus (HBV) infection in endemic regions. The World Health Organization (WHO) aims to reduce HBV seroprevalence among children under five to less than 0.1% by 2030. In Malaysia, the seroprevalence of hepatitis B surface antigen (HBsAg) in children has declined to 0.4%, but additional measures are needed. A pilot study in Sarawak, Malaysia, screened 474 pregnant women for HBsAg. Those with high MTCT risk received tenofovir disoproxil fumarate from 28 weeks of gestation to 12 weeks postpartum. Infants received timely birth-dose HBV vaccine and hepatitis B immunoglobulin (HBIG) where indicated. Among screened women, 1.9% were HBsAg positive, with 55.6% newly diagnosed. No MTCT cases were observed. Risk factors included maternal age over 35 years old household exposure, and sexual transmission risk. These findings demonstrate the feasibility of WHO's PMTCT strategies in low-resource settings, supporting nationwide expansion in Malaysia.

Background Maternal hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain major contributors to perinatal and early childhood hepatitis transmission in India. Despite national guidelines recommending universal antenatal screening, coverage gaps persist. This study aimed to determine the prevalence, associated risk factors, and preventive outcomes of HBV and HCV among pregnant women in Lucknow District, North India. Objectives The primary objectives of this cross-sectional study were to determine the prevalence of HBVand HCVamong pregnant women attending antenatal clinics (ANCs) at primary and secondary health facilities in Lucknow; to assess the risk factors associated with HBV and HCV infection among pregnant women; and to study pregnancy outcomes among HBV/HCV-positive pregnant women. Additionally, we documented whether neonates born to HBV-positive mothers received standard immunoprophylaxis, including hepatitis B immunoglobulin (HBIG) and the hepatitis B birth-dose vaccine. Methods A hospital-based cross-sectional study was conducted among 2005 pregnant women attending ANCs. Serum samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies using rapid diagnostic kits at the health facilities, followed by viral load assessment at the Model Treatment Centre (MTC). Sociodemographic, obstetric, and exposure-related data were analyzed using univariate and multivariate logistic regression to identify independent predictors. The timely administration of the hepatitis B birth-dose vaccine and HBIG to neonates born to hepatitis-positive mothers, in accordance with established national protocols, was also documented. Results The overall prevalence of viral hepatitis among pregnant women was 2.8%, including 2.5% HBsAg positivity and 0.3% anti-HCV positivity, with no observed co-infection. Prevalence was higher among women aged ≥25 years. Independent predictors of infection included a sibling history of hepatitis (adjusted odds ratio (AOR) 11.68, p=0.001), unsafe injections administered by unqualified practitioners (AOR 5.07, p=0.024), sharing of sharp instruments such as blades or razors (AOR 5.58, p=0.018), a history of jaundice or prior HBsAg positivity (AOR 5.93, p=0.021), and a family member receiving treatment for HBV or HCV (AOR 15.36, p=0.003). Maternal clinical parameters were reviewed to facilitate appropriate referral and follow-up care in accordance with ethical guidelines. Conclusion This study underscores the importance of universal antenatal screening and regulation of unsafe injection practices. The implementation of comprehensive maternal screening in conjunction with timely neonatal immunoprophylaxis may contribute to reducing vertical transmission and aligns with India's commitment to the World Health Organization's 2030 hepatitis elimination agenda.

Evaluating the Use of Hepatitis B Immunoglobulin After Liver Transplant.

Despite standard immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and hepatitis B vaccination, a proportion of infants born to hepatitis B surface antigen (HBsAg)-positive mothers still experience mother-to-child transmission (MTCT) of hepatitis B virus (HBV). The molecular mechanisms underlying immunoprophylaxis failure remain incompletely understood. Long non-coding RNAs (lncRNAs) are increasingly recognized as important regulators of antiviral immune responses; however, their role in HBV MTCT has not been fully elucidated. Peripheral blood mononuclear cells (PBMCs) were collected from infants born to HBsAg-positive mothers with either successful or failed MTCT prevention, as well as from healthy controls. Whole-transcriptome RNA sequencing was performed to identify differentially expressed mRNAs and lncRNAs. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were conducted to explore the associated biological functions and pathways. An lncRNA-mRNA co-expression network was constructed to identify potential regulatory relationships. Key genes were further validated using real-time quantitative PCR (RT-qPCR). A total of 2,647 differentially expressed mRNAs and 1,082 differentially expressed lncRNAs were identified between the MTCT prevention failure group and the successful prevention group. Functional enrichment analysis revealed that these genes were mainly involved in immune-related biological processes, including cytokine-mediated signaling, neutrophil activation, and innate immune responses. KEGG pathway analysis demonstrated significant enrichment in pathways related to hepatitis B, MAPK signaling, and NOD-like receptor signaling. The lncRNA-mRNA co-expression network identified 440 potential regulatory interactions associated with MTCT blockade failure. RT-qPCR validation demonstrated that HRAS expression was significantly downregulated in the MTCT blockade failure group, whereas ICAM1, NAMPT, and SOD2 were significantly upregulated compared with healthy controls. Our findings reveal distinct transcriptomic profiles associated with HBV MTCT and suggest that dysregulated immune-related genes and lncRNA-mRNA regulatory networks may be associated with MTCT prevention failure. In particular, altered expression of HRAS, ICAM1, NAMPT, and SOD2 may represent candidate biomarkers associated with HBV MTCT related to HBV transmission and immune responses in infants. These findings provide preliminary insights into the molecular characteristics of HBV MTCT and may help guide future mechanistic and clinical studies.

ABSTRACT To evaluate progress toward MTCT elimination of HBV, we analyzed 8-y trends in hepatitis B vaccine (HepB) and hepatitis B immune globulin (HBIG) administration coverage rates in Shandong province, focusing on high-risk populations. Data were collected from a provincial system, Shandong Vaccination Information System. Information of maternal HBsAg+ neonates born in 2017–2024 were extracted. Administration coverage in four groups (A: general newborn, B: maternal HBsAg+ neonates, C: preterm neonates with HBsAg+ mother, and D: birthweight <2000 g (LBW2000) neonates with HBsAg+ mother) were calculated. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC). From 2017 to 2024, the maternal HBsAg+ rate dropped from 2.85% to 2.10% (APC = -0.10, P < .001), with an accelerating rate of decrease after 2021. Timely HepB birth dose (HepB-BD) vaccination coverage rose annually, reaching 94.42% in Group C (APC = 4.92, P = .001) and 86.26% in Group D (APC = 5.86, P < .001). Timely HBIG administration coverage increased significantly before 2021, achieving high levels by 2024 except in Group D (93.96%). The 4th dose of HepB (HepB4) vaccination coverage in Group D showed a nonsignificant increase (56.51% to 72.93%), with median administration time decreasing from 13.24 to 8.59 months. MTCT Elimination of HBV has improved substantially. However, LBW2000 neonates born to HBsAg+ mothers require focused attention, particularly regarding administration coverage of timely HBIG and HepB4. Enhanced health education for parents and additional clinical training for healthcare providers are needed to improve intervention coverage.

BackgroundHBV is the primary blood-borne pathogen of occupational exposure among healthcare workers (HCWs) in China. This study aims to analyze the characteristics of occupational exposure to HBV, and the ultimate goal is to optimize post-exposure management strategies for medical personnel.MethodsData of serum HBV markers (HBV-M) from a routine physical examination of HCWs in 2022 were retrieved, and characteristics of HBV-M were analyzed. Registration information of HBV occupational exposure from 2018 to 2022 was collected, and related risk factors were analyzed. HCWs injected with hepatitis B immunoglobulin (HBIG) were followed up.Results4,419 HCWs underwent physical examination, and there were nine patterns of HBV-M identified. HBsAg positive rate was 1.54%, and anti-HBs positive rate was 65.6%. There were 161 HBV occupational exposure incidents with no cases of HBV infection. Among categories of related factors for occupational exposure, occupation as a nurse, work experience < 5 years, sharp instruments as disposable needles, places of exposure as general wards, and operational processes as during surgical procedures were risk factors accounting for the highest proportion, respectively. 36 individuals received HBIG injection after exposure. One month after HBIG injection, the anti-HBs non-responder group at baseline showed low anti-HBs titers, which turned negative three months later.ConclusionsHBsAg positive rate is relatively low among HCWs, while anti-HBs positive rate is slightly higher than that of the general population. The management and control of major exposure factors should be strengthened. One month after HBIG injection might be the optimal timing for catch-up vaccination of hepatitis B vaccine.Clinical trial registrationThis study does not involve any clinical trials. Clinical trial number is not applicable.

Introduction: Post exposure prophylaxis (PEP) is a treatment that can be used after possible exposure to the hepatitis B virus through sex, drug injecting equipment or injury such as needle stick injury. Post-exposure prophylaxis can help prevent hepatitis B to many health care workers after being exposed to hepatitis virus. Due to the frequent contact with patients’ blood, bodily fluids, needles, nurses are more susceptible to contact with HBV infection. The overall objective of the research was to assess the knowledge on post exposure prophylaxis of hepatitis B among undergraduate nursing students. Method: A descriptive cross-sectional study was carried out among 148 nursing students in Manmohan Memorial Institute of Health Sciences using probability proportionate stratified random sampling technique. Ethical approval was taken from the Institutional Review Committee (IRC) of Manmohan Memorial Institute of Health Sciences, MMIHS. Informed consent was taken from the study participants. Data was collected using self-developed structured questionnaire from Jestha 20 to 32, 2081 (2024 June 2nd to 2024 June 14). The collected data was analyzed in SPSS version 23.0 using descriptive statistics and inferential statistics chi-square test was done to explore the association between variables and interpretation was done. Results: Out of 148 respondents, more than half(52.7%) had adequate level of knowledge on meaning of PEP(85.85), common constituents of Hepatitis B PEP(77.7%),indication of PEP (72.3%), meaning of Hepatitis B Immunoglobulin (HBIG) (68.2%), route of HBIG(71.6%). But there was inadequate level of knowledge on efficacy of PEP(23.0%), types of exposure(12.2%), adequate value of HBsAg titre (10.8%), standard PEP for positive source patient and vaccinated exposed person with inadequate HBsAg titre (9.5%). There was statistically significant association between academic year (p=0.001), vaccination status(p=0.025) with level of knowledge on PEP. Conclusion: About half of the respondents have inadequate knowledge on PEP of Hepatitis B, there is gap in knowledge on standard protocol of PEP. Therefore, nursing students should be updated on PEP by revising curriculum.

ABSTRACTChronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma (HCC). Post‐transplant HBV reinfection represents an important post‐liver transplantation (LT) complication, which can result in death or graft loss. Hepatitis B immunoglobulin (HBIG) has proven effective in preventing reinfection; however, its high cost and patient inconvenience underscore the need for alternative strategies. In this study, we evaluated the long‐term outcomes of HBV‐positive LT recipients who received very short‐term HBIG immunoprophylaxis combined with life‐long antiviral therapy. We conducted a single‐center, retrospective cohort study of patients who underwent LT for HBV between 2002 and 2022. Viremic patients received an intraoperative and six consecutive daily doses of HBIG, while non‐viremic patients received two doses only post‐LT, along with long‐term antiviral therapy. The primary outcome was HBV reinfection. Secondary outcomes included death‐censored graft survival and overall survival. Seventy‐six patients were included. Of these, only three experienced HBV reinfection over the study period. The cumulative incidence of reinfection at 1, 12, 24, and 48 months was observed to be 1.37%, 2.76%, 2.76%, and 2.76%, respectively. The 1‐, 3‐, and 5‐year death‐censored graft survival rates were 94%, 94%, and 92%, respectively. The 1‐, 3‐, and 5‐year overall survival rates were 92%, 92%, and 85%, respectively. A very short‐term HBIG protocol produced excellent post‐transplant outcomes for HBV‐positive LT recipients, with very low rates of HBV reinfection and excellent graft and overall survival.

Hepatitis B vaccination and immune globulin administration in patients presenting to the emergency department following sexual assault.

Background: Hepatitis B virus (HBV) is a major public health issue, leading to cirrhosis and hepatocellular carcinoma. Vertical transmission of HBV can be effectively prevented with timely immunoprophylaxis, post-vaccination follow-up, and serological testing. Objectives: The aim of this study is to assess real-life adherence to follow-up protocols for hepatitis B surface antigen (HBsAg)-positive mothers and their infants in our center. Methods: We retrospectively reviewed records of 137 HBsAg-positive mothers and 167 infants born between 2017 and 2022. Data on hepatitis B immunoglobulin (HBIG) and vaccine administration at birth, as well as rates and timing of postnatal serological testing (anti-HBs, HBsAg, anti-HBc IgG), were analyzed. Hepatitis B e antigen (HBeAg), HBV DNA results, and antiviral treatment data of the mothers during pregnancy follow-up were also analyzed. Results: All infants received the first dose of the hepatitis B vaccine at birth, and 163 infants (97.6%) received HBIG at birth. However, only 12.5% of infants underwent anti-HBs testing, and just 10.6% were tested at the recommended age. Among those tested appropriately, 70.5% achieved protective anti-HBs levels. It was determined that serologic follow-up was performed more frequently in infants of mothers who received antiviral treatment during pregnancy (P &lt; 0.001). Conclusions: While birth-dose immunoprophylaxis rates were high, post-vaccination serological follow-up was markedly insufficient. This discrepancy emphasizes the necessity of implementing uniform follow-up procedures, educating healthcare professionals, and raising awareness among families to ensure better adherence to established HBV management protocols.

Background and Objectives:Hepatitis B virus (HBV) remains a major public health challenge, particularly in hyperendemic regions. This study assessed the effectiveness of Iran’s national HBV vaccination program in Esfandiar village, South Khorasan Province, where HBV prevalence substantially exceeds the national average. We compared hepatitis B surface antigen (HBsAg) prevalence between cohorts born before and after implementation of the universal vaccination program in 1993.Materials and Methods:We conducted a cross-sectional seroprevalence study encompassing both unvaccinated individuals (born before 1993) and vaccinated individuals (born 1993 onwards) in Esfandiar village. Serum samples were analyzed for HBsAg, hepatitis B e antigen (HBeAg), and hepatitis B core antibody (HBcAb) using enzyme-linked immunosorbent assay (ELISA).Results:HBsAg prevalence was markedly higher among unvaccinated individuals (22.56%, 132/585) compared to vaccinated individuals (1.19%, 3/252), yielding a vaccine effectiveness of 94.74%. Among vaccinated children, 54% maintained protective antibody titers (>10 mIU/mL), with highest levels observed in children born to HBsAg-positive mothers. Conversely, 46% of vaccinated children demonstrated suboptimal antibody titers (<10 mIU/mL), predominantly among those born to HBsAg-negative mothers. Notably, all three HBsAg-positive vaccinated children were born to mothers with concurrent HBsAg and HBeAg positivity.Conclusion:The national HBV vaccination program demonstrates remarkable effectiveness in reducing HBsAg prevalence, underscoring the critical importance of universal neonatal immunization in endemic settings. Enhanced preventive strategies, including hepatitis B immunoglobulin (HBIG) administration to infants of HBeAg-positive mothers, could further optimize protection. Sustained surveillance and rigorous adherence to vaccination protocols remain essential for achieving comprehensive HBV control.

ABSTRACTBackground & AimsDespite recommendations from scientific societies that hepatitis B immunoglobulin (HBIG) can be safely discontinued, centres across Europe continue to use the combination nucleoside analogues (NAs) plus HBIG for long‐term prophylaxis against hepatitis B virus (HBV) recurrence after liver transplant (LT). The aim of this study was to evaluate the safety of HBIG withdrawal in a cohort of LT recipients on long‐term HBIG+NAs.MethodsAll patients under third‐generation NAs + HBIG and who adhered to the INSIGHT‐B protocol were followed up after HBIG withdrawal, in a multicentre, prospective, Italian cohort study, to evaluate the risk of HBV reactivation. The probability of HBsAg reappearance after HBIG withdrawal, stratified by presence of HCC at LT, was estimated through Kaplan–Meier curves and Log‐rank tests.ResultsBetween February 2021 and January 2024, 222 liver transplant (LT) recipients withdrew HBIG 11.6 (IQR 6.7–17.0) years after LT and were followed up for a median time of 24 months. After HBIG withdrawal, Hepatitis B surface antigen (HBsAg) reappearance was observed in 12 patients (5.4%) with a cumulative 1‐, 2‐ and 3‐year recurrence rate of 4.08%, 5.36% and 6.89% respectively. HBsAg serum levels remained very low over the entire period of observation (median 9 months, range 3–20), and in four cases fluctuated around the detectability threshold. In all cases, HBV‐DNA persisted undetectable, liver function tests (LFTs) remained within the normal range, and neither HBV‐related hepatitis nor HCC were observed. No baseline patients' features were found to be significantly associated with the likelihood of HBsAg reappearance after HBIG withdrawal, including the presence of HCC at transplantation.ConclusionsHBIG could be safely withdrawn in HBV mono‐infected LT recipients on long‐term combination HBIG plus third generation NAs.

Evaluation of Ultra-Short Course Hepatitis B Immune Globulin (HBIG) in Combination with Antiviral Agents for Hepatitis B Recurrence Prevention in Liver Transplant Recipients

Context: Chronic Hepatitis B virus (HBV) infection affects 260 million people globally, causing 900,000 deaths annually due to cirrhosis and hepatocellular carcinoma (HCC). Mother-to-child transmission (MTCT) is a major contributor to this burden. While birth dose vaccination and Hepatitis B immunoglobulin (HBIG) are key prevention strategies, they are insufficient for mothers with high viral loads. Objectives: Tenofovir disoproxil fumarate (TDF) has emerged as an effective intervention to prevent MTCT of HBV. Data Sources: This systematic review and meta-analysis evaluated the efficacy of TDF in preventing MTCT of HBV. A comprehensive search was conducted across PubMed, Embase, and the Cochrane Library. Study Selection: The inclusion criteria focused on randomized controlled trials (RCTs) assessing TDF in pregnant women with HBV. Quality assessment was performed using the adapted Newcastle–Ottawa Scale. Data Extraction: The DerSimonian and Laird random-effects model was employed to determine pooled effect sizes, with heterogeneity assessed using Cochran’s Q and I2 statistics. All analyses were conducted using Stata/MP 17.0. Results: The search identified 1909 records, with 160 studies meeting the inclusion criteria after rigorous screening and quality assessment. The meta-analysis included 43 studies on TDF's effectiveness in preventing MTCT of HBV based on HBsAg detection. The pooled odds ratio (OR) from the random-effects model indicated a significant reduction in HBV transmission with TDF treatment compared to control groups. Moderate heterogeneity was observed (I2 = 52.48%), but the overall effect remained statistically significant [OR = 0.38, 95% onfidence interval (CI): 0.29 - 0.50, P &lt; 0.001]. Additionally, analysis based on the trimester of TDF administration showed consistent effectiveness with no observed heterogeneity (I2 = 0.00%). For studies focusing on HBV DNA levels, significant heterogeneity was noted (I2 = 80.94%), yet TDF treatment consistently showed a significant reduction in transmission (OR = 0.25, 95% CI: 0.18 - 0.36, P &lt; 0.001). Conclusions: The TDF is effective in reducing MTCT of HBV, supporting its use in maternal health programs. Further research should refine treatment protocols and address specific populations to enhance prevention strategies.

Post-Liver Transplantation Hepatitis B Prophylaxis in Canada: Results of a National Survey.