Funding: No financial support was received for completion of this study.
Substitution of tenofovir/emtricitabine for Hepatitis B immune globulin prevents recurrence of Hepatitis B after liver transplantation
Version of Record online: 21 FEB 2012
© 2012 John Wiley & Sons A/S
Volume 32, Issue 7, pages 1138–1145, August 2012
How to Cite
Todd Stravitz, R., Shiffman, M. L., Kimmel, M., Puri, P., Luketic, V. A., Sterling, R. K., Sanyal, A. J., Cotterell, A. H., Posner, M. P. and Fisher, R. A. (2012), Substitution of tenofovir/emtricitabine for Hepatitis B immune globulin prevents recurrence of Hepatitis B after liver transplantation. Liver International, 32: 1138–1145. doi: 10.1111/j.1478-3231.2012.02770.x
- Issue online: 2 JUL 2012
- Version of Record online: 21 FEB 2012
- Manuscript Accepted: 24 JAN 2012
- Manuscript Received: 6 DEC 2011
- antiviral therapy;
- nucleo(s)tide analogue;
- HBV DNA polymerase inhibitor;
- hepatitis B;
- liver transplantation
Hepatitis B immune globulin (HBIg) with or without nucleos(t)ide analogue (NA) inhibitors has been shown to prevent recurrence of hepatitis B virus (HBV) following orthotopic liver transplantation (OLT). However, the use of HBIg has many disadvantages.
The present study was performed to determine if converting patients from HBIg±NA to combination NA therapy could prevent recurrence of HBV.
Twenty-one recipients without evidence of HBV recurrence on HBIg±NA for ≥6 months were enrolled. Patients received their last injection of HBIg at the time they initiated tenofovir disoproxil fumarate/emtricitabine (TDF/FTC; Truvada®) and were followed up for 31.1 ± 9.0 [range 15–47] months.
After 1 year, 3 patients (14%) had detectable HBsAg, one of whom was non-compliant. Two of 3 with recurrence cleared HBsAg by last follow-up on TDF/FTC; the non-compliant patient became HBV DNA-undetectable with re-institution of TDF/FTC. TDF/FTC saved $12,469/year over our standard-of-care, monthly intramuscular HBIg/lamivudine. There was no evidence of a general adverse effect of TDF/FTC on renal function. However, 3 patients developed reversible acute renal failure; on renal biopsy, 1 had possible TDF/FTC-induced acute tubular necrosis.
Substitution of TDF/FTC for HBIg prevented recurrence of HBV DNA in 100% (20/20) of patients who were compliant with the medication and led to substantial cost savings over HBIg-containing regimens.