Background  

Hepatitis B (HBV) is an uncommon indication for liver transplantation in the US accounting for approximately 5% of cases. Recurrence prophylaxis is typically long-term hepatitis B immune-globulin (HBIg) and an oral anti-HBV agent. Because of high HBIg costs and improving efficacy of new oral agents, there is increasing interest in HBIg discontinuation.

Aim  

To describe results of a protocol at our center including HBV vaccination and HBIg discontinuation.

Methods  

All patients received HBIg therapy and an oral anti-viral agent from the time of transplant. Patients transplanted for HBV with a stable post-operative clinical course underwent HBV vaccination and HBIg discontinuation. After HBIg discontinuation, patients were monitored for HBV recurrence for at least one year. Recurrence was defined as either viral (HBV-DNA 10⁴ copies/ml on two consecutive occasions) or hepatitis (viral recurrence with elevated liver transaminases).

Results  

Of 1182 recipients, 36 (3%) had HBV. Twenty-four were excluded from the protocol, and the remaining 12 patients underwent HBIg withdrawal. Median age at HBIg discontinuation was 56 (range, 36–70) years, median time from transplant to HBIg discontinuation was 62.8 (range, 27.5–128) months, and median time of follow-up after discontinuation was 27.4 (range, 13–69) months. Of the 12 patients vaccinated, no patients maintained HBSAb ≥ 10 IU/l at last follow-up. There was no viral or hepatitis recurrence and no deaths or graft loss.

Conclusions  

HBIg discontinuation with maintenance oral anti-viral monotherapy is safe and effective for HBV liver transplant recipients. Vaccination is not effective in this population.