Detailed Abstract
[Liver Poster Presentation 4]
[LV PP 4-2] Real-World Hepatitis B Prophylaxis after Liver Transplantation in Korea: Analysis of the KOTRY Database
Byeong-Gon NA1, Shin HWANG*1, Dong-Hwan JUNG1, Gi-Won SONG1, Myoung-Soo KIM2
1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
2Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Korea
Introduction : Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients.
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 a wide concentration 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 anti-HBs titers >500 IU/mL and >1000 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.
Conclusions : 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.
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 a wide concentration 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 anti-HBs titers >500 IU/mL and >1000 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.
Conclusions : 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.
SESSION
Liver Poster Presentation 4
E-Session 7/27 ~ 7/29 ALL DAY