HBIg Therapy Among Liver Transplant Patients With HBV/HDV Coinfection

Patients with chronic hepatitis B virus (HBV) who received HBV immunoglobulins (HBIg) as prophylaxis before and after liver transplantation have demonstrated excellent long-term survival—even during short-term treatment of 4 to 8 weeks. However, investigators recently reported, the impact of HBIg prophylaxis and its duration on patients coinfected with HBV and hepatitis D (HDV) has been unknown.

“Data on HDV recurrence and its impact on outcomes after LT [liver transplantation] are limited. In this review, we evaluated the available data on post-LT recurrence of HBV and/or HDV,” the authors wrote in a review published in Liver International. “Overall, HBIg prophylaxis was effective, but 10-13% of patients became HBsAg positive after LT.”

Because all the studies reviewed by the investigators involved continuous administration of HBIg prophylaxis, the rates of recurrence of HBV without HBIg prophylaxis are not known. The authors did note that a German study revealed that “the clinical course and histopathological aspects of liver injury,” specifically inflammation, fibrosis, and steatosis were similar in post-transplant patients on continuous HBIg and those who stopped HBIg after a median of 72 months.

Discontinuing HBIg among stable patients after liver transplant for HBV/HDV coinfection appeard not to lead to reduced overall rates of survival or higher rates of HBV recurrence in this long-term follow-up, they concluded.

“In summary, discontinuation of HBIg after liver transplantation for HBV/HDV liver disease seems safe, but randomized controlled studies are needed before it can be generally recommended,” the authors wrote.

—Rebecca Mashaw

Reference:

Ferenci P, Reiberger T, Stadlbauer V, Zoller G. Transplantation of hepatitis D virus patients: Lifelong hepatitis B immunoglobulins? Liver Int. Published online ahead of print, June 29, 2022.

DOI: 10.1111/liv.15352