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Post-transplantation Hepatitis B Prophylaxis with Combination Oral Nucleoside and Nucleotide Analog Therapy S. Saab, S. Desai, D. Tsaoi, F. Durazoa, S. Hana, A. McClune, C. Holt, D. Farmer, L. Goldstein and R. W. Busuttil Article Summary The most common strategy for thwarting Hepatitis B recurrence in the liver transplant patient is using a combination of hepatitis B immune globulin (HBIg) along with an oral antiviral agent like lamivudine.
Despite the remarkable success of this method, the use of lifelong HBIg for hepatitis B prophylaxis has its limitations. Among others are the high cost, limited supply and parental administration. The patient needs to frequently visit the clinic too and requires laboratory monitoring. Another problem with HBIg is it’s a blood product not readily advised by physicians. If a safer non-biological alternative existed, it would have been very easy for the patients. This particular study examined 61 patients that went under donor orthotopic liver transplantation (OLT). The study found that the HBIg cessation a 12 months minimum after the transplant with successive administration of nucleoside and nucleotide analog agent gives an effective prophylaxis against recurring HBV infection. Despite the success of the procedure concerns still persist when applying the same procedure to patients with chronic stable renal dysfunction. One recurrence case in the study seroconverted to HBsAg while being administered oral antivirals (to treat renal dysfunction). Hence renal dysfunction does represent a complication in applying this procedure. ...
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