Hepatitis B prophylaxis after liver transplantation in Korea: Analysis of the KOTRY database

Gil Chun Park, Shin Hwang, Myoung Soo Kim, Dong Hwan Jung, Gi Won Song, Kwang Woong Lee, Jong Man Kim, Jae Geun Lee, Je Ho Ryu, Dong Lak Choi, Hee Jung Wang, Bong Wan Kim, Dong Sik Kim, Yang Won Nah, Young Kyoung You, Koo Jeong Kang, Hee Chul Yu, Yo Han Park, Kyung Jin Lee, Yun Kyu Kim

Research output: Contribution to journalArticle

Abstract

Background: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population. Methods: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis. Results: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence. Conclusion: Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.

Original languageEnglish
Article numbere36
JournalJournal of Korean medical science
Volume35
Issue number6
DOIs
Publication statusPublished - 2020 Feb 17

Keywords

  • Antiviral agent
  • Hepatitis B immunoglobulin
  • Hepatitis B virus
  • Liver transplantation
  • Recurrence

ASJC Scopus subject areas

  • Medicine(all)

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    Park, G. C., Hwang, S., Kim, M. S., Jung, D. H., Song, G. W., Lee, K. W., Kim, J. M., Lee, J. G., Ryu, J. H., Choi, D. L., Wang, H. J., Kim, B. W., Kim, D. S., Nah, Y. W., You, Y. K., Kang, K. J., Yu, H. C., Park, Y. H., Lee, K. J., & Kim, Y. K. (2020). Hepatitis B prophylaxis after liver transplantation in Korea: Analysis of the KOTRY database. Journal of Korean medical science, 35(6), [e36]. https://doi.org/10.3346/jkms.2020.35.e36