Nucleos(t)ide analog(s) prophylaxis after hepatitis B immunoglobulin withdrawal against hepatitis B and D recurrence after liver transplantation

Background/aims Nucleos(t)ide analogs ( NA s) have made a hepatitis B immunoglobulin ( HBIG )‐sparing protocol an attractive approach against hepatitis B virus ( HBV ) recurrence after liver transplantation ( LT ). However, this approach is considered controversial in patients transplanted for HBV and hepatitis D ( HDV ) co‐infection. Material/Methods All patients transplanted for HBV / HDV cirrhosis were evaluated. After LT , each patient received HBIG + NA s and then continued with NA s prophylaxis. All patients were followed up with HBV serum markers and HBV DNA , while anti‐ HDV / HDV RNA was performed in those with HBV recurrence. Results A total of 34 recipients were included (22 men, age: 46.7 ± 16 years). After HBIG discontinuation, NA s were received as monoprophylaxis (lamivudine [ LAM ]: 2, adefovir [ AFV ]: 1, entecavir: 9, tenofovir [ TDF ]: 12) or dual prophylaxis ( LAM + AFV [or TDF ]: 10 patients). Two (5.8%) of the 34 patients had HBV / HDV recurrence after HBIG withdrawal (median follow‐up: 28 [range, 12–58] months). These 2 patients had undetectable HBV DNA at LT . Statistical analysis revealed that those with recurrence had received HBIG for shorter period, compared to those without recurrence (median: 9 vs. 28 months, P = 0.008). Conclusions We showed for the first time, to our knowledge, that maintenance therapy with NA s prophylaxis after HBIG discontinuation was effective against HBV / HDV recurrence, but it seems that a longer period of HBIG administration might be needed before it is withdrawn after LT .