Histological outcome after liver transplantation for chronic hepatitis B using oral antiviral therapy alone without hepatitis B immune globulin

Abstract

AIM: To determine the histological outcome after liver transplantation for patients with chronic hepatitis B (CHB) receiving oral antiviral therapy without hepatitis B immune globulin (HBIG). METHODS: All patients transplanted for CHB-related complications from January 2003 to December 2012 were included. None of the patients received HBIG. All biopsies performed 3 months after transplantation were analyzed. Biopsies were performed on the basis of graft dysfunction. Immunohistochemical study with anti-hepatitis B surface antigen (HBsAg) antibody was performed. RESULTS: A total of 440 CHB patients underwent liver transplantation with a median follow-up of 58 months (range, 0-130). Of these, 139 (31.6%) patients underwent liver biopsy for graft dysfunction, with a total of 258 biopsies performed. The median time to biopsy was 10 months (range, 3-104). Forty-five patients had positive serum HBsAg at the time of biopsy, of which 6 were positive for HBsAg stain. All 6 patients were on lamivudine with known virological rebound due to resistance. In the remaining 39 patients with negative HBsAg stain, 7 patients had grade 1 fibrosis from non-HBV related causes. Forty patients were on entecavir monotherapy, of which 9 patients were positive for serum HBsAg at the time of biopsy and all were negative for HBsAg staining; only 1 had grade 1 fibrosis from non-hepatitis B cause. In the remaining 94 patients who were HBsAg-negative at the time of biopsy, none had histological evidence of recurrence of hepatitis B. CONCLUSION: For patients without virological rebound, positive serum HBsAg was not associated with histological evidence of recurrent hepatitis B infection after liver transplantation. For patients receiving entecavir monotherapy, no histological evidence of recurrent hepatitis B was observed irrespective of the serum HBsAg status.