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Hepatitis B Prophylaxis after Liver Transplantation in Korea: Analysis of the KOTRY Database

Authors
 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 
Citation
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.35(6) : e36, 2020-02 
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
ISSN
 1011-8934 
Issue Date
2020-02
MeSH
Antiviral Agents* / therapeutic use ; Cohort Studies ; DNA, Viral / blood ; Drug Therapy, Combination ; Hepatitis B Surface Antigens / blood ; Hepatitis B virus* / genetics ; Hepatitis B* / prevention & control ; Humans ; Immunoglobulins* / therapeutic use ; Liver Transplantation* ; Living Donors* ; Registries ; Republic of Korea
Keywords
Hepatitis B Virus ; Recurrence ; Liver Transplantation ; Hepatitis B Immunoglobulin ; Antiviral Agent
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.
Files in This Item:
T9992020493.pdf Download
DOI
10.3346/jkms.2020.35.e36
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190268
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