Nov 1—Hepatitis B
Experimental Therapies
459.
Complementary and Alternative Medicine Use in Children with Chronic Viral
Hepatitis
J.
Erlichman; B. Haber
Objective:
To assess prevalence, rationale and factors associated
with use of complementary and alternative medicine (
Methods:
Sixty-three self-administered questionnaires were
completed by parent-proxy or child with diagnosis of chronic hepatitis B
(55.9%) or hepatitis C (44.1%)virus infection. The
questionnaire included 25 questions regarding: socio-demographic information
for patient and parent, type of viral hepatitis and medical history, types of
Results:
Forty-six percent of children tried at least one
Seventy-five percent of respondents said they spent
less than $25.00 a month on
Conclusion:
1.
2. Rate of physician non-disclosure
is high. Medical practitioners caring for this patient population must be
cognizant of the possible use of
Diagnostic
Tools
K. E.
McGoogan; W. F. Berman; R. Jhaveri
Background:
AST-to-platelet ratio index (APRI) has been studied in
adults as a possible correlate with degree of liver fibrosis on biopsy in
patients with chronic hepatitis B or hepatitis C. Studies in children have been
limited. The purpose of the study was to investigate whether APRI could serve
as a non-invasive marker of fibrosis in children with chronic viral hepatitis.
Methods:
All patients 0 – 20 years old with a diagnosis of
chronic hepatitis B or C seen at tertiary medical center from
Results:
Forty-eight patients with chronic HCV and HBV were
evaluated with a mean age of 12.4. 50% of the patients were male, 29% had
hepatitis B and 71% had hepatitis C. The mean fibrosis score was 1.6. ROC
curves were generated which revealed areas under the curve of 0.60 -0.63 for
cirrhosis and significant fibrosis, respectively. The APRI was better at
predicting significant fibrosis (METAVIR score >2), than predicting cirrhosis,
but was still a very crude marker for fibrosis.
Conclusion:
The APRI has limited value in predicting the presence
of significant fibrosis in these patients. Further research into this and other
potential non-invasive markers of fibrosis in pediatric patients with chronic
viral hepatitis is warranted.
Diagnostic
Tools
515.
Analyzing HBV-
C. P.
Eyigun; O. Coskun; H. C. Gul; E. Gunal; A. Kubar; I. Y. Avci; H. Erdem; B. A.
Besirbellioglu; L. Gorenek
Background:
Some patients with positive HBsAg and unexplained
elevated
Materials
and Methods:
Sixty-three HBsAg positive, serum HBV-
Results:
The average age of the patients was 27±9.37 years. The
average of
Conclusion:
Despite new molecular techniques provide rapid and
accurate quantification of serum HBV-
HBV
Treatment – Adefovir and Lamivudine Resistance
C. P.
Eyigun; H. C. Gul; O. Coskun; E. Gunal; H. Erdem; I. Y. Avci; L. Gorenek; B. A.
Besirbellioglu; A. Kubar
Background:
Although lamivudine used for chronic hepatitis B is a
potent and well-tolerated drug, there is an increasing resistance parallel to
its duration of usage. Addition of adefovir dipivoxil to therapy for patients
with resistance to lamivudine seems to prevent adefovir resistance. The aim of
this study was to asses the effectiveness of adding adefovir dipivoxil to
therapy for lamivudine resistant patients, and to define the long-term
follow-up results for emergence of adefovir resistance.
Materials
and Methods:
Ten milligrams of adefovir dipivoxil was added to the
therapy of 75 patients with chronic hepatitis B who developed virological
and/or biochemical breakthrough under long-term lamivudine therapy. Serum HBV-
Results:
The mean age of the patients was 42,6
± 12,82 years. Thirty nine patients were HBeAg positive at the beginning of the
therapy. After a median 118 (24-268) weeks of follow-up, no adefovir resistance
emerged. The average duration for HBV
Conclusion:
Addition of adefovir to ongoing lamivudine therapy in
chronic hepatitis B patients with lamivudine resistance is safe and efficient.
It is well-known that switching lamivudine to adefovir dipivoxil in lamivudine
resistant chronic hepatitis B patients results in substantial adefovir
resistance. So continuation of lamivudine in these patients seems to prevent
genotypic resistance to adefovir and clinical breakthrough.
Lamivudine
Resistance
C. P.
Eyigun; E. Gunal; A. Kubar; H. C. Gul; O. Coskun; I. Y. Avci; H. Erdem; L.
Gorenek; B. A. Besirbellioglu
Background:
The aim of this study is to demonstrate the lamivudine
resistance in liver tissue of the patients whose serum
Material and
Method:
Fourteen patients under lamivudine therapy were
included in the study. Ten cases with elevated
Results:
The patients were 22 to 41 years old (median 41.5
years) and their alt levels were 13 to 104 IU/L (median 39.5 IU/L). They were
under lamivudine therapy in a range of one to 10 years (median five years).
YMDD mutation was shown for all 14 patients in their liver tissue. One patient
had rtM204V, four patients had rtL180M, two had rtL180M + rtM204V, four had
rtL180M + rtM204I, and three patients had rtL180M + rtM204I + rtM204V
substitutions.
Conclusion:
Analyzing mutation in liver tissue of the patients
with elevated
Lamivudine
Resistance
M.
Mendes-Correa; J. R. Pinho; O. M. Leite; L. G. Martins; A. G. Leite; M. H.
Silva; R. Sitnik; D. E. Uip
Background:
Information on the genotype distribution and frequency
of lamivudine (LAM) resistance mutations in HIV-HBV co-infected patients is
scarce, especially in
Methods:
847 HIV positive patients followed at a single
institution were tested for HBV infection. All patients were submitted to
hepatitis B surface antigen detection with commercial available kits. HBV viral
load was determined by using an in house real time
Results:
A total of 34 HBV-HIV-coinfected patients (4.0%) were
identified. Plasma specimens with detectable HBV viremia could be obtained from
26 patients and this was the study population that underwent further
virological characterization. All but 5 patients had received LAM. Median time
on LAM was 48 months. HBV genotype distribution was: A (n=10 – 38.5%), D (n=3 –
11.5%), G (n=2 – 7.6%) and F (n=1 – 3.8%).
Among 21 patients who received LAM, 5 were also
receiving tenofovir. In these patients, HBV-
Among 16 patients who had received LAM alone, LAM resistance
mutations were detected in 8 (50%) patients. rtL180M+rtM204V was the most
frequent resistance mutation pattern (n= 6). This pattern was found with
accompanying mutation rtV173L in 2 individuals. This nucleotide change produces
a simultaneous sE164D mutation in the overlapping surface antigen-reading
frame. V207I alone was found in one patient, who had never received lamivudine.
Only 5 patients (23.8%) out of 21 treated for at least 12 months with LAM
presented sustained virological response.
Conclusions:
In this group of co-infected patients:1) HBV genotypes A and D predominate;2) HBV genotype G,
(previously reported in Brazil in one homosexual men) was found in 7.6%
patients; 3) rtV173L/sE164D, a vaccine escape related mutation, was found in
two patients; 4) Therapy with LAM was effective in only 23.8% of patients and
was associated with different lamivudine resistance mutations, including
mutations that alters HBsAg antigenicity.
Epidemiology,
Transmission, and Prevention Issues – Disease Awareness
W.
Li-Ping; L. Wah-Yun; C. Ng; M. Rosmawati
Objectives:
Prevalence of chronic Hepatitis B varies widely from
0.01% to 20% through the world. The data from Malaysian Liver
Foundation in 1998 shows that the estimated prevalence of HBsAg among Malaysian
general population was 4.7%. It has been widely reported that lack of
knowledge affect prevention, treatment and healthcare. This study assessed the
knowledge/awareness of basic facts of the disease among hepatitis B patients.
Methods:
A total of 483 hepatitis B patients attending the
hepatology clinic at the University of Malaya Medical
Center (UMMC),
Results:
Respondents had a mean age of 46.3 (SD=14.7) years,
majority (48.7%) have had at least a secondary education, and the mean duration
of diagnosis was 12 years (SD= 8.8) years. Near half of the respondents could
not differentiate whether hepatitis B is a viral (37.2%) or bacterial infection
(45.0%). Majority were aware that the clinical consequences of hepatitis B
infection include inflammation of the liver (81.7%), liver failure (78.6%) and
liver cancer (85.3%). Only 59.6% aware of symptoms of liver disease, with
jaundice (89.6%), nausea and vomiting (58.2%), and tiredness (53.6%) as most commonly
cited symptoms. Knowledge of modes of transmission was adequate with a majority
proportion of correct responses above 70th percentile. The most common modes of
transmission mentioned were blood transfusion (90.7%), causal contact (87.8%),
mother-to-child transmission (83.9%), and sexual intercourse (79.3%).
Forty-five and 5/10 percent (45.5%) have misperception that sharing utensils
can transmit the hepatitis B virus.
Conclusion:
Despite the relatively high education level among
participants in this study, there are still gaps in knowledge among the
hepatitis B patients, especially in terms of symptoms of liver disease. Misconception about the
mode of transmission still exist and this could potentially lead to
unnecessary social isolation and negative impact on quality of life.
The results also suggest that more attention is needed
at providing health education on hepatitis B to young patients and those above
the age of 60 years old, patients of lower educational level, in newly
diagnosed hepatitis B and cirrhotic patients.
Disease
Progression
D. Y.
Dao; H. Yuan; C. Sanders; N. Attar; L. S. Hynan; M. K. Jain; R. Word; W. M. Lee
Background:
Acute hepatitis B-related liver failure (HBV-
Design/Methods:
Data were collected prospectively on 92 HBV-
Results:
Admission VLs of HBV-
Conclusion:
Remarkably low VLs are found in most HBV-
Liver
Transplantation
586.
Liver Transplantation Trends and Survival in the Asian Population
N.
Kemmer; V. C. Zacharias; T. E. Kaiser; G. W. Neff
Studies to address ethnic minorities in liver
transplantation (LT) have traditionally focused on African Americans and
Hispanics. Although, the Asian population accounts for 4.4% of the
Method:
Using the UNOS database, we identified all adult LT
recipients (age > 18 yrs) between 1998 and 2007. The data collected included
demographics, diagnosis, survival data and UNOS region. Statistical analysis
was done using Kaplan-Meier (KM) and log-Rank tests for survival analysis.
Results: During the study period, 1953 patients received LT, accounting for
4.1% of all adult LT. Of these, there were 1286 (65.8%) males with a median age
of 55 (range 18 – 75). The underlying liver disease was hepatitis B (28.1%),
Hepatitis C (18.4%),
Conclusion:
(1) Regional
variation and differences in liver disease pattern was seen among Asian
population with HBV-
|
Year |
Asian |
AA |
Hispanic |
Caucasian |
|
PATIENT |
||||
|
1 |
89% |
84% |
88% |
87% |
|
3 |
81% |
72% |
80% |
79% |
|
5 |
76% |
65% |
74% |
73% |
|
GRAFT |
||||
|
1 |
84% |
79% |
83% |
83% |
|
3 |
76% |
65% |
75% |
74% |
|
5 |
71% |
57% |
68% |
67% |
Liver
Transplantation
A. F.
Lok; S. B. Han; E. R. Schiff; R. S. Brown; S. Emre; C. Soldevila-Pico; K.
Reddy; M. Ishitani; E. B. Keeffe; V. A. Luketic; B. Degertekin
Background
and Aims:
Prophylaxis with antiviral therapy and hepatitis B
immune globulin (HBIG) have decreased but not eliminated HBV recurrence
post-OLT. We determined the HBV recurrence rate in a cohort of patients
prospectively followed in the NIH HBV-OLT study and the impact of antiviral
breakthrough pre-OLT and HBIG regimens post-OLT on HBV recurrence rate.
Methods:
Data from the NIH HBV-OLT database were analyzed. HBV
recurrence defined as detection of HBsAg >1 month after OLT was estimated by
Kaplan-Meier and factors associated with HBV recurrence were analyzed by Cox
regression.
Results:
191 patients (76% men, mean age 52 years, 41%
Caucasian, 44% Asian) from 15 centers transplanted for HBV between 3/01 and
9/07 were followed for a median of 41 months (0-81) post-OLT. 51% were
transplanted for
Conclusion:
In this
Liver
Transplantation
597.
Total and Covalently Cosed Circular
I.
Lenci; G. Tisone; D. Di Paolo; L. Tariciotti; M. Ciotti; F. Marcuccilli; T.
Guenci; C. F. Perno; M. Angelico
Background:
The recommended life-long prophylaxis in patients
transplanted due to HBV-related cirrhosis is extremely costly and there are no
current criteria to assess whether can be withdrawn. The risk of HBV
reactivation is due to persistence of the viral genome in the form of
covalently closed circular (ccc)
Patients and
Methods:
Total and cccDNA were detected using a nested- and
real-time
Results:
Among the initial cohort of patients screened for total
and cccDNA, 1 had HBV recurrence after transplant and detection of total and
cccDNA was positive. In the other 43 liver biopsies total and cccDNA resulted
negative. Among the 30 patients who underwent HBIG withdrawal, 29 resulted
total and cccDNA negative. Only 1 patient was found to be total and cccDNA
positive.
Conclusions:
In this cohort of transplant recipients at low risk of
HBV recurrence who received the recommended HBV prophylaxis for a minimum of 5
years and who did not exhibit viral breakthrough after transplant no evidence
of intrahepatic cccDNA was found in the liver. These patients are unlikely to
undergo HBV recurrence and, if data will be confirmed in more extensive
follow-up, could be cautiously considered for complete prophylaxis withdrawal.
Liver
Transplantation
L.
Katz; M. Paul; D. Guy; L. Leibovici; R. Tur-Kaspa
Background:
Recurrence of hepatitis B virus (HBV) infection is a
major problem for patients undergoing liver transplantation for HBV cirrhosis. The use of post transplantation hepatitis B immuneglobulins (HBIg),
antiviral drugs or a combination of both decrease recurrence rates.
Method:
We conducted a systematic review and meta-analysis in
order to evaluate these three strategies.
The Cochrane Central Register of Controlled Trials,
MEDLINE, LILACS, and EMBASE were searched until December 2007. Clinical trials
and comparative cohort studies, comparing the use of HBIg, anti virals or both
following liver transplantation for HBV infection were included. The outcomes
assessed were: all cause and HBV-related mortality; HBV related active liver
disease; and reappearance of hepatitis B surface antigen (HBsAg) or HBV
A total of 19 studies (21 comparisons) were included.
Three were randomized controlled trials (RCT); two prospective studies with
historical controls; and 14 retrospective studies. Three studies, 133 patients,
(two RCT) compared lamivudine to HBIg; 10 studies, 651 patients, compared HBIg
alone to combination treatment; and 8 studies, 649 patients,(one
RCT) compared lamivudine to combination treatment. There was no significant
difference between HBIg and lamivudine when given alone, in all measured
outcomes. Combination treatment was superior to HBIg alone in all outcome
measures: it reduced overall mortality (RR 0.44 0.25-0.77), HBV-related
mortality (RR 0.12, 0.05-0.30), HBV-related active liver disease (RR 0.16,
0.07-0.37) and HBV recurrence (RR 0.28, 0.12-0.66 for HBsAg re-appearance and
RR 0.21, 0.04-0.98 for HBV
Conclusion:
1. Combination treatment was
significantly better than lamivudine alone only in preventing HBsAg re-appearance
(RR 0.30, 0.21-0.43). There was a tendency favoring combination treatment for
HBV related mortality (0.31, 0.09-1.10) and active liver disease (0.40,
0.15-1.02).
2. Combination treatment with
HBIg and lamivudine reduces overall mortality with a number needed to treat of
6 patients compared to HBIg alone and prevents more cases of HBV recurrence
after liver transplantation.
3. Combination treatment can
include low-dose HBIg.
4. When compared to
lamivudine alone it prevents HBsAg re-appearance more efficiently. Results are
based mainly on non-randomized studies.
Liver
Transplantation
599
Tenofovir Is Effective in Suppressing HBV Replication in Liver Transplant
Recipients with Nucleos(t)ide
Resistant Recurrent Disease
L.
Lilly; G. Therapondos; A. L. Mason; K. W. Burak
Background:
Liver disease and hepatoma due to hepatitis B (HBV)
remain important indications for liver transplantation (LT). Results have
improved dramatically in the past decade with the widespread use of nucleoside
therapy in combination with HBIG following LT to prevent graft reinfection.
However, breakthrough due to genotypic resistance occurs in approximately 5% of
cases, requiring the addition or substitution of newer antiviral agents.
Tenofovir disoproxil (TNF) has been shown to be effective in controlling HBV in
wild-type and lamivudine-resistant (LAM-R) disease; however, its role in nucleos(t)ide resistant HBV in LT recipients has not been
well defined.
Aims:
To examine the outcomes of LT recipients with
drug-resistant recurrent HBV treated with TNF. Methods: Data was collected from
two large Canadian LT centers, the
Results:
Fifteen patients were identified. Mean age at
transplant was 52y (31-68) and all were male. HBeAg/eAb information was
available in 12 patients pre-LT, and 10 were eAb (+). Eight patients were on
LAM at the time of LT; one other had been treated in the past. Ten patients had
serum HBVDNA measured within 3m of LT and 6 had detectable levels. After LT,
fourteen patients either continued or were started immediately on LAM; the other
started on LAM 32m post LT. Eleven patients also received HBIG for 4-30m
according to center protocols. LAM-R developed at a mean of 27m (1-66). Ten
patients immediately received TNF. Three others were switched to TNF after
entecavir was ineffective. Two had TNF introduced after they
developed resistance or renal toxicity while on adefovir. Serum HBVDNA
at time of TNF ranged up to >2000pg/mL or >1x10E9 copies/mL. Mean
follow-up is 26m (8-72m). Serum HBVDNA has fallen dramatically in all; 12 have
undetectable levels, attained after a mean of 10m of TNF. All patients are
alive with normal graft function and normal or improving normal biochemistry.
One patient required TNF dose reduction for renal insufficiency. To date, no
TNF resistance has developed.
Conclusions:
·
TNF is effective and well tolerated in drug-resistant HBV in
LT recipients.
·
In all of the patients there was a dramatic decline in HBV
Liver
Transplantation
H. K.
Niho; D. J. Quan; J. P. Roberts; F. Yao; N. Terrault; M. G. Peters
Background:
Hepatitis B may reactivate after immunosuppresssion
even in those who have lost HBsAg. Vaccination of recipients is critical to protect
against de novo HBV but is less effective in patients with end stage liver
disease. De novo hepatitis B has been described among recipients of liver
transplants from donors with evidence of past HBV infection, including donors
with anti-HBc alone. While the majority of HBV replication occurs in the liver,
extra-hepatic replication can occur. Whether these sites are a source of cccDNA
is unclear.
Aim:
To investigate whether liver
transplant recipients with serologic evidence of past HBV infection (anti-HBc ±
anti-HBs positive) are at risk for de novo HBV after liver transplantation
(OLT).
Methods:
Medical records of all patients undergoing OLT at UCSF
from
Results:
During the study period, 2,005 patients underwent
liver transplantation, and 583 were excluded because they were transplanted for
HBV or had evidence of previous vaccination. The study cohort included 206
patients in Group 1, 240 in Group 2, and 976 in Group 3. The median follow up
was 54 months with a range of 0-242. There was no difference between groups in
age at OLT or ethnicity. Markers of past HBV were more common in males 72%
(Groups 1&2) versus 52% (Group 3) and those with HCV infection 48-52%
(Groups 1&2) versus 22.5% (Group 3). De novo HBV occurred in 1% of groups 1
and 2 and 1.8% of group 3 (ns). When donor HBV status was evaluated, de novo
HBV occurred in 11.5% of recipients of anti-HBc positive donors, only one of
whom was on nucloes(t)ide prophylaxis at the time.
Overall, 77% of transplant patients who received anti-HBc positive donors
received prophylaxis with nucleos(t)ide analogues. De
novo HBV developed in 0.5% of those receiving HBV negative livers.
Conclusions:
De novo HBV is not increased in liver transplant recipients
with evidence of past HBV infection unless they receive organs that are
anti-HBc positive. There may be no or insufficient cccDNA in extrahepatic
stores, and thus reactivation of HBV under immune suppression rarely occurs.
Liver
Transplantation
M. Prieto; A. Rubin; M. Berenguer; V. Aguilera; S.
Benlloch; C. Ortiz
Background:
Different strategies have been developed to minimize
the risk of hepatitis B in recipients of livers from HBcAb+ donors but their
long-term efficacy is largely unknown.
Aim:
To report the long-term results with
the use of grafts from HBcAb+ donors using a selective assignation protocol.
Methods:
HBcAb+ grafts were used whenever possible in HBsAb+
and/or HBcAb+ recipients or in hepatitis B recipients (matched group). In this
group, only hepatitis B recipients received HBV prophylaxis (HBIG plus
lamivudine). If no appropriate recipients existed on the waiting list, HBcAb+
livers were used in naïve HBsAb- HBcAb- patients (unmatched group) and
prophylaxis with im HBIG (2.000 U /monthly before july 2001) or lamivudine
(after july 2001) was administered.
Results:
From 1999 to 2006, 124 (14.7%) out of 844 patients
received a HBcAb+ graft at our center. The study
population consisted of 103 recipients with at least 3 months of HBV follow-up
(median 3.6 years, range: 0.2-8 years). Overall, 12 (11.6%) recipients developed
hepatitis B, defined as detection of HBsAg on at least 2 occasions, at a median
time of 18,5 months (range: 3-77) following OLT. In the matched group (n=57),
only 1 (6.7%) of the 15 hepatitis B recipients developed HBV infection. In the
42 anti-HBs+ and/or anti-HBc+ recipients, the risk of hepatitis B differed
according to their HBV serological profile at the time of OLT (table 1).
In the unmatched group (n=46), 38 naïve patients
received HBV prophylaxis and 8 did not. Hepatitis B developed in 4 (50%) out of
8 naïve recipients not receiving any prophylaxis and in 3 (8%) out of 38 who
received it (p=0.01). In the latter group, only 1 (3.7%) of the 27 patients who
received lamivudine alone developed hepatitis B vs 2 (25%) out of 8 who
received HBIG as initial prophylaxis (p=0.12). 5-year patient survival was 56%
in patients who developed hepatitis B vs 74% in those who did not(p=ns). Only one death was due to HBV-related liver
failure.
Conclusions:
A selective assignation strategy in which HBcAb positive
grafts are first used in HBsAb+ and/or HBcAb+ patients or in HBV recipients is
safe in the long-term. Different risk groups, however, can be identified
according to the recipient’s pre-OLT HBV serological profile. Lamivudine alone
is very effective in reducing the risk of hepatitis B in naïve recipients and
its efficacy appears to be superior to that of HBIG alone.
Table 1:
|
pre-OLT HBV markers |
n |
hepatitis B (n, %) |
|
HBsAb+ alone |
4 |
0 (0%) |
|
HBsAb+ HBcAb+ |
22 |
1 (4.5%) |
|
HBcAb+ alone |
16 |
3 (18.8%) |
Liver
Transplantation
C. S.
Coffin; P. M. Mulrooney-Cousins; M. G. Peters; J. P. Roberts; T. I. Michalak;
N. Terrault
Background:
Despite effective prophylaxis, recurrent serologically
evident HBV infection occurs, albeit infrequently. Elevated serum HBV
Aim:
We determined HBV status in liver, PBMC and plasma at
LT in patients with HBV
Results:
At the time of LT, all were receiving antiviral
therapy; 4/9 treated for lamivudine (LAM) resistant HBV (1 with concurrent
adefovir,
|
Age/Sex |
Pre-LT HBV |
||||
|
Plasma |
Explant |
Explant cccDNA |
PBMC |
PBMC cccDNA |
|
|
59 M |
UD* |
C S X |
<200 |
NA |
NA |
|
66 M |
UD |
C S X |
<20 |
NA |
NA |
|
50 M |
3540* |
C S X |
<20 |
NA |
NA |
|
50 M |
UD |
C S X |
<20 |
X |
NA |
|
60 M |
C |
C S X |
<20 |
UD |
NA |
|
67 M |
UD |
C S X |
<20 |
C S |
<20 |
|
63 F |
C X |
C S P X |
<200 |
C S P |
UD |
|
55 M |
UD |
C S X |
<200 |
UD |
NA |
|
38 M |
UD |
C S |
<20 |
UD |
NA |
*clinical test ~6 mo pre-LT
Liver
Transplantation
612.
Oral Antiviral Therapy Without Hepatitis
B Immunoglobulin to Prevent De Novo Hepatitis B in Hepatitis B Core Antibody
Positive Liver Transplant Recipients
R.
Potru; S. M. Cohen; S. F. Dodson; J. Ahn
Background:
Up to 50% of patients receiving hepatitis B core
antibody (HBcAb) positive donor livers may acquire de novo hepatitis B (HBV)
infection after liver transplant (LT) in the absence of prophylactic therapy.
Hepatitis B immunoglobulin (HBIG) reduced incidence to 0-20%, but is costly and
inconvenient to administer. Small studies have suggested that nucleos(t)ide analogue therapy (
Methods:
All patients undergoing LT at our center from HBcAb +
donors from 2002 and 2008 were identified retrospectively. Our center did not utilize
any HBIG in HBcAb + liver graft recipients during the study period. Recipients
with HBV and those who did not receive
Results:
Thirty-six patients were identified. 29/36 (81%) were
placed on LAM. 7/36 (19%) were placed on LAM and
Conclusions:
Liver
Transplantation
P.
Lampertico; M. Viganò; S. Bhoori; F. Agnelli; M. Donato; M. Bongini; M.
Iavarone; C. Cotsoglou; A. Russo; L. Caccamo; G. Rossi; M. Colombo; V.
Mazzaferro
Background
and Aim:
The long-term outcome of hepatitis B virus (HBV)
infected patients who underwent liver transplantation (LT) because of
hepatocellular carcinoma (
Results:
Seventy-eight patients were followed-up for a median
of 48 (2-110) months. Five patients (6%) showed
Conclusions:
Cirrhotic patients undergoing liver transplantation
for HBV-related
Liver
Transplantation
M.
Angelico; D. Di Paolo; I. Lenci; L. Tariciotti; A. Monaco; F. Marcuccill2; C.
Perno; G. Tisone
Background:
Post-transplant active immunization with HBsAg vaccine
is a potential prophylaxis strategy against HBV-recurrence after liver
tranplantation due to HBV-related disease. Previous studies showed conflicting
results using standard vaccines, whereas the use of the new adjuvant
3-deacylated monophosphoryl-lipid-A (MPL) significantly increased patient’s
immunization rate through an high anti-HBs titre
increase. Aim: We investigated the efficacy of a long-term (12 months) and
accelerated (monthly doses) vaccination schedule using the MPL-adjuvanted
recombinant S vaccine administered with and without concomitant HBIg.
Methods:
Eighteen patients (M/F:13/5)
transplanted for HBV-related cirrhosis 73±38 months earlier were recruited. All
were HBsAg and HBV
Results:
All patients completed the whole vaccination program,
receiving 12 adjuvanted vaccine doses (first and second protocol phase) and
were monitored during 6 months follow-up after vaccination end (third protocol
phase). No side effects occurred, nor evidence of HBV recurrence. At the end of
first phase 18/18 (100%) patients achieved an anti-HBs titre greater than 100
IU/L (mean 393±391 IU/L) and 3 (16.6%) a titre greater than 500 IU/L. At the
end of follow-up 9/18 (50%) and 2/18 (11,1%) had an
anti-HBs titre greater than 100 (mean 851±599 UI/L) and 500 IU/L, respectively.
Conclusions:
Twelve months after HBIg withdrawal and 6 months after
last vaccine dose half of the patients reached and maintained a presumably
protective anti-HBs titre (>100 IU/L). This intensive schedule using the
MPL-adjuvanted recombinant S vaccine, given in combination with HBIG and
lamivudine, seems to be more effective than previous HBV vaccination protocols
with standard alum-adjuvanted vaccine. Data on the long-term maintenance of a
protective anti-HBs titre and confirmation of these results in a larger number
of patients are urgently needed before incorporating this prophylactic strategy
in the management of transplant recipients with previous HBV-related diseases.
Liver
Transplantation
A.
Takaki; T. Yagi; Y. Iwasaki; H. Sadamori; Y. Umeda; S. Shinoura; H. Matsuda; T.
Yasunaka; Y. Miyake; H. Kobashi; N. Tanaka; K. Yamamoto
Background:
Combination therapy with hepatitis B immunoglobulin
(HBIg) and lamivudine has become accepted as the best way to control hepatitis
B after liver transplantation. However, the HBIg dose and the target HBs
antibody titer have not been determined. Recently, hepatitis B virus vaccine is
also applied for post transplantation hepatitis B prevention. Herein, we report
our experience using low-dose HBIg combined with lamivudine for hepatitis B and
subsequently application of monthly hepatitis B vaccine.
Methods:
The study included 27 end-stage hepatitis B virus
related liver failure patients who received living donor liver transplantation
(LDLT) and survived longer than 6 months; 5 with acute liver failure and 22
with liver cirrhosis. Six months after LDLT, HBIg was administered if the
patient’s HBsAb titer was <10 IU/l. Lamivudine was administered to 2/5 of
acute liver failure patients and of all cases with liver cirrhosis. Hepatitis B
virus vaccine was administered to all patients with acute liver failure longer
than one year after LDLT. Six of 22 patients with liver cirrhosis type B
received vaccine longer than one and a half year after LDLT.
Results:
All of the five acute liver failure patients showed
HBs antibody (Ab) positive after 3 to 5 times inoculation of vaccine. Of the
liver cirrhosis patients, 2 patients had transient HBsAg recurrence, but
reintroduction of HBIg restored their HBsAg-negative status. Of the 6 patients
who received vaccine, 2 turned HBs Ab positive after 7 and 9 months of monthly
vaccine administration.
Conclusion:
Low-dose HBIG with lamivudine reliably and
cost-effectively controlled hepatitis B virus reactivation after LDLT. Hepatitis
B virus vaccine was 100% effective in acute liver failure patients that should
be administered. Hepatitis B vaccine was effective in only selected patients
with liver cirrhosis but should be tried since vaccine effective or
non-effective patients could not be predicted.
Liver
Transplantation
H. . Yim; S. Park; J. Kim; Y. Jung; J. Kim; Y. Seo; J. Yeon; S. Um; K.
Byun
Background
and Aim:
Patients with liver cirrhosis are considered to be at
increased risk of mortality and morbidity after surgery. Several factors
associated with postoperative mortality have been identified, including
increasing scores of Child-Pugh-Turcotte, model for end stage liver disease
(MELD), and American Society of Anesthesiologists (ASA) class, but it is still
difficult to predict postoperative outcomes in individual patient accurately.
Most recently, a new model for the prediction of postoperative mortality risk in
patients with cirrhosis was developed by Mayo clinic. The prediction model,
which adopts variables such as ASA, MELD, and age, was based on mortality rate
of cirrhotic patients who had undergone surgery under general anesthesia from a
single hospital. Therefore it is unclear if the model could be applied to the
cirrhotic patients at other centers, especially in Eastern countries which may
have different etiology and prognosis of liver cirrhosis. To validate the
usefulness of this model in Asian cirrhotic patients, we performed the present
study.
Methods:
One hundred nine medical records from the patients who
underwent surgery under general anesthesia at
Results:
A total of 17 patients (23.3%) died after surgery.
MELD, ASA, and emergency surgery were proved to be independent risk factors for
mortality by univariate analysis, but only ASA remained to be a risk factor by
multivariable proportional hazards model. The areas under the receiver
operating curve (AUC) of the prediction model were 0.988, 0.921, and 0.871 for
30 days, 90 days, and 1 year mortality, respectively. However, actual mortality
were 5.4%, 10.9%, and 15.1% at 30 days, 90 days, and 1 year, respectively,
which are lower than the predictive values of 7.2±5.9%, 11.2±8.2%, 22.6±8.5%.
The difference between actual and predictive mortality rate at 1 year was significantly
different (p<0.001)
Conclusions:
The risk prediction model, which was developed by Mayo
clinic is also considered to a useful model in Asian
cirrhotic patients. However, the model tends to overestimate the mortality,
especially at the time of 1 year after surgery.