Hepatitis B vaccination could be an effective and promising alternative strategy to long-term administration of hepatitis B immune globulin and nucleotide analogues for preventing hepatitis B virus (HBV) reactivation in liver transplant recipients, according to a study published in the Journal of Viral Hepatitis.
Liver transplantation is the most effective treatment for patients with HBV-related end-stage liver diseases. Standard prophylaxis to prevent HBV reinfection after transplantation in these patients is long-term administration of nucleotide analogues and hepatitis B immune globulin.
In addition to high costs, long-term administration of these drugs can lead to the development of escape mutations and/or emerging strains, and it is unclear how long treatment should be continued. Therefore, researchers in China retrospectively analyzed 78 liver transplantation recipients responding to hepatitis B vaccination after stopping hepatitis B immune globulin and/or nucleotide analogues. These patients had normal or near normal liver function and were treated prophylactically with hepatitis B immune globulin and nucleotide analogues for at least 18 months following transplantation. They received hepatitis B vaccination at 0, 1, 2, and 6 months as one round of inoculation. Hepatitis B immune globulin and nucleotide analogues were maintained during the inoculation period. Once the patient was defined as a responder, exogenous hepatitis B immune globulin and nucleotide analogues administration was discontinued. The researchers found that during follow‐up, only 4 patients experienced HBV reinfection, which was associated with HBV escape mutations, after the withdrawal of both hepatitis B immune globulin and nucleotide analogues. In addition, no death or graft loss occurred during the follow‐up period.
The authors concluded that, “A careful withdrawal of [hepatitis B immune globulin] and/or [nucleotide analogues] is feasible and safe for responders to hepatitis B vaccination receiving transplants for HBV‐related liver diseases.”
Duan B‐W, Tian L‐T, Lin D‐D, et al. Long‐term consequences of stopping HBIG and/or nucleotide analogues in liver transplant recipients administered hepatitis B vaccination to prevent HBV reinfection. J Viral Hepat. 2019;26(Suppl 1):85-89.