Dept of Gastroenterology & Hepatology, Indraprastha Apollo Hospital, New Delhi, India; Dept of Surgical Gastroenterology & Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India.
Background: HBIG is routinely used in liver transplant for HBV related liver disease. With potent oral antivirals, use of HBIG may not be required. We conducted a prospective trial to evaluate liver transplantation without HBIG in LRLT. Methods: 89 patients with HBV related liver disease underwent LRLT from January 2005 to January 2012. All donors were vaccinated with HBV vaccine. All patients were given oral antivirals for HBV before transplant. Patients with HBV DNA < 2000 IU/ml were not given HBIG, with DNA > 2000 IU/ml were given HBIG. Recurrence was defined as HBV DNA positivity 6 months post transplant. Results: Seventy-five of the 89 patients who underwent LRLT for HBV related liver disease were not given HBIG. Nineteen patients received a combination of Lamivudine and adefovir, 42 entecavir, 12 tenofovir and 2 a combination of entecavir with tenofovir. At last follow-up (median 21 months; range 1-83), all patients were HBV DNA negative. Sixty-six patients cleared HBsAg, 19 patients formed anti HBsAb. The cumulative probability of clearing HBsAg was 90% at 1 year and 92% at 2 years post transplant. Nine patients were HBsAg positive with undetectable DNA at last follow up. The recurrence rate in our series was 8% (6/75). Five of these six had stopped oral antivirals and 1 had entecavir resistance. All recurrences were salvaged with change in oral antivirals. The actuarial probability of survival in this cohort was 73.7% at 83 months. There was no mortality due to HBV recurrence. Conclusions: HBV prophylaxis with oral antivirals without HBIG is safe and effective in LRLT. Majority of patients clear HBsAg and a proportion develop anti HBs antibody.