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Lai Q, Mennini G, Giovanardi F, et al. Immunoglobulin, nucleos(t)ide analogues and hepatitis B virus recurrence after liver transplant: A meta-analysis. Eur J Clin Invest. 2021;51(8):e13575doi: 10.1111/eci.13575.
Lai, Q., Mennini, G., Giovanardi, F., Rossi, M., & Giannini, E. G. (2021). Immunoglobulin, nucleos(t)ide analogues and hepatitis B virus recurrence after liver transplant: A meta-analysis. European journal of clinical investigation, 51(8), e13575. https://doi.org/10.1111/eci.13575
Lai, Quirino, et al. "Immunoglobulin, nucleos(t)ide analogues and hepatitis B virus recurrence after liver transplant: A meta-analysis." European journal of clinical investigation vol. 51,8 (2021): e13575. doi: https://doi.org/10.1111/eci.13575
Lai Q, Mennini G, Giovanardi F, Rossi M, Giannini EG. Immunoglobulin, nucleos(t)ide analogues and hepatitis B virus recurrence after liver transplant: A meta-analysis. Eur J Clin Invest. 2021 Aug;51(8):e13575. doi: 10.1111/eci.13575. Epub 2021 May 03. PMID: 33866547; PMCID: PMC8365701.
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Eur J Clin Invest. 2021 Aug;51(8):e13575. doi: 10.1111/eci.13575. Epub 2021 May 03.

Immunoglobulin, nucleos(t)ide analogues and hepatitis B virus recurrence after liver transplant: A meta-analysis.

European journal of clinical investigation

Quirino Lai, Gianluca Mennini, Francesco Giovanardi, Massimo Rossi, Edoardo G Giannini

Affiliations

  1. General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Rome, Italy.
  2. Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

PMID: 33866547 PMCID: PMC8365701 DOI: 10.1111/eci.13575

Abstract

BACKGROUND: Prophylaxis with hepatitis B immunoglobulin (HBIG) represents an efficient strategy for reducing the risk of hepatitis B virus (HBV) recurrence after liver transplantation (LT). Unfortunately, the long-term use of HBIG presents high costs. Therefore, the use of prophylaxis based only on nucleos(t)ide analogues (NUC) has been recently postulated. The present meta-analysis aimed to evaluate the impact of HBIG ± NUC vs HBIG alone or NUC alone in post-LT HBV recurrence prophylaxis.

MATERIALS AND METHODS: A systematic literature search was performed using PubMed and Cochrane databases. The primary outcome investigated was the HBV recurrence after LT. Three analyses were done comparing the effect of (a) HBIG + NUC vs HBIG alone; (b) HBIG+NUC vs NUC alone; and (c) HBIG alone vs NUC alone. Sub-analyses were also performed investigating the effect of low and high genetic barrierto-recurrence NUC.

RESULTS: Fifty-one studies were included. The summary OR (95%CI) showed a decreased risk with the combination of HBIG + NUC vs HBIG alone for HBV recurrence, being 0.36 (95% CI = 0.22-0.61; P < .001). HBIG + NUC combined treatment reduced HBV reappearance respect to NUC alone (OR = 0.22; 95% CI = 0.16-0.30; P < .0001). Similarly, HBIG alone was significantly better than NUC alone in preventing HBV recurrence (OR = 0.20; 95% CI = 0.09-0.44; P < .0001).

CONCLUSIONS: Prophylaxis with HBIG is relevant in preventing post-LT HBV recurrence. Its combination with NUC gives the best results in terms of protection. The present results should be considered in light of the fact that also old studies based on lamivudine use were included. Studies exploring in detail high genetic barrier-to-recurrence NUC and protocols with definite use of HBIG are needed.

© 2021 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

Keywords: adefovir; entecavir; lamivudine; liver transplantation; nucleos(t)ide analogues; prophylaxis

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