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- Date2021-02-23 16:39
- Update2021-02-23 16:39
- CountersignatureDivision of Research Planning
Journal of Korean Medical Science, 2020.35(6), 1-13, DOI: https://doi.org/10.3346/jkms.2020.35.e36
Hepatitis B Prophylaxis after Liver Transplantation in Korea: Analysis of the KOTRY Database
Shin Hwang, Gil-Chun Park; 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
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.
Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.
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.
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.
- DOI: https://doi.org/10.3346/jkms.2020.35.e36
- ISBN or ISSN: 1011-8934
- 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
- This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.