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Long-term HBV prophylaxis found safe for pediatric LT recipients with HBV-positive grafts

A new study published in Liver Transplantation showed that long-term prophylaxis against de novo hepatitis B was safe and effective for protecting pediatric liver transplant recipients from contracting the infection after receiving a liver graft positive for the infection.

“Our regimen is as effective — or even more so — as previously used regimens, and the cost is far less,” Suk-Koo Lee, MD, PhD, of the Sungkyunkwan University School of Medicine, Korea, said in a press release. “Also, it is safe to use and patients require less than one injection per year on average.”

Lee and colleagues sought to determine long-term outcomes of a prophylaxis regimen against de novo hepatitis B, combined with HBV vaccine and hepatitis B immunoglobulin (HBIG), among pediatric liver transplant recipients of hepatitis B core antibody-positive liver grafts. Forty-one patients were enrolled and given de novo hepatitis B prophylaxis, known as HBV vaccine intramuscular injections, intermittently to maintain antihepatitis B surface antibody (HBsAb) titer levels above 100 IU/L, according to the research. HBIG was also used during 1 year post-transplant with the goal of maintaining an antibody level greater than 200 IU/L.

Of the patients, 22 were girls and 19 were boys, with a median age of 1 year. The median follow-up was 66 months post-transplant.

Overall, 2.4% of the patients experienced new-onset HBV during the median follow-up (n = 1), which was diagnosed 3.5 years post-transplant. The anti-HBsAb level was 101.5 IU/L at the time in this patient, according to the research.

“No grafts were lost due to de novo hepatitis B-related events. … Four patients did not require any HBV vaccine injections during follow-up,” the researchers wrote.

The overall survival of the patients was 92.3% 10 years post-transplant.

“[The regimen’s] safety, simplicity and cost-effectiveness make our [it] a better fit for pediatric liver transplant recipients, since they must receive hepatitis B prophylaxis longer than their adult counterparts,” Lee said. – by Melinda Stevens

Disclosure: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.