Source Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
BACKGROUND & AIMS: We investigated the efficacy of entecavir, a cyclopentyl guanosine nucleoside analog, as monoprophylaxis in patients with chronic hepatitis B who received liver tranplants.
METHODS: We studied data from 80 consecutive patients who received liver transplantation (47 from living donors and 33 from deceased donors) for hepatitis B-related disease and entecavir monotherapy as prophylaxis. None of the patients received hepatitis B immunoglobulin (HBIG). Indications for transplantation included decompensation from cirrhosis (27.5%), acute-on-chronic hepatitis B (47.5%), and hepatocellular carcinoma (25%). The median follow-up time was 26 months (range, 5-40 months). Before transplantation, 33 patients were not on antiviral therapy and 47 were on oral therapy (18 had received less than 3 months of treatment).
RESULTS: At the time of transplantation, the median log HBV DNA level was 3.5 copies/mL (range, 1.54-8.81); 21 patients (26%) had undetectable levels of HBV DNA. The cumulative rate of hepatitis B surface antigen (HBsAg) loss was 86% and 91% after 1 and 2 years respectively. Ten patients had re-appearance of HBsAg. Eighteen patients (22.5%) were HBsAg-positive at the time of their last examination; 17 of these had undetectable levels of HBV DNA, and remaining patient had a low level of HBV DNA (217 copies/mL). There was no evidence of mutations at sites that confer resistance to entecavir among patients who were HBsAg positive.
CONCLUSION: Although only 26% of patients had complete viral suppression at the time of transplantation, 91% lost HBsAg, with 98.8% achieving undetectable levels of HBV DNA. An HBIG-free regimen of entecavir monotherapy is effective after liver transplantation for chronic hepatitis B.