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Hepatitis B immunoglobulins and/or lamivudine for preventing hepatitis B recurrence after liver transplantation: A systematic review

Authors

  • Jie Chen,

    1. Beijing Friendship Hospital, Capital Medical University; Municipal Key Laboratory of Beijing for Regulation of Liver Protection and Regeneration. Beijing, China
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  • Liping Yi,

    1. Beijing Friendship Hospital, Capital Medical University; Municipal Key Laboratory of Beijing for Regulation of Liver Protection and Regeneration. Beijing, China
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  • Ji Dong Jia,

    1. Beijing Friendship Hospital, Capital Medical University; Municipal Key Laboratory of Beijing for Regulation of Liver Protection and Regeneration. Beijing, China
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  • Hong Ma,

    1. Beijing Friendship Hospital, Capital Medical University; Municipal Key Laboratory of Beijing for Regulation of Liver Protection and Regeneration. Beijing, China
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  • Hong You

    1. Beijing Friendship Hospital, Capital Medical University; Municipal Key Laboratory of Beijing for Regulation of Liver Protection and Regeneration. Beijing, China
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Ji Dong Jia, Capital Medical University, Beijing Friendship Hospital, Beijing, China. Email: jiamd@263.net

Abstract

Background:  Currently, hepatitis B immunoglobulins (HBIg) and/or lamivudine have become the main options for prevention of hepatitis B recurrence after liver transplantation.

Aim:  To assess the benefits of HBIg and/or lamivudine for prevention of hepatitis B recurrence after liver transplantation.

Methods:  We conducted a search of electronic databases and a manual search of bibliographical lists of relevant articles. All randomized clinical trials and non-randomized studies that meet the pre-specified criteria were included. However, results of non-randomized studies were reported under ‘exploratory analyses’ in the result section. The outcome measure was hepatitis B recurrence.

Results:  Two randomized and 44 non-randomized studies were included. Meta-analysis of two randomized studies shows one week HBIg combined with lamivudine regimen had equivalent effect compared with long-term high-dose HBIg regimen for preventing hepatitis B recurrence (RR 1.23; 95% CI 0.38–4.03; P = 0.73). For 44 non-randomized studies, only qualitative systematic review was performed. With long-term HBIg prophylaxis, hepatitis B recurrence rate ranged from 3.7% to 65%; with lamivudine prophylaxis, hepatitis B recurrence rate varied from 3.8% to 40.4%; Long-term high-dose HBIg plus lamivudine prophylaxis can reduce the risk of HBV recurrence to less than 10%.

Conclusions:  Long-term HBIg prophylaxis or lamivudine prophylaxis can reduce the risk for hepatitis B virus recurrence. Long-term high-dose HBIg combined with lamivudine can further reduce HBV recurrence to less than 10%.

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