Prevalent use of combined prophylaxis of hepatitis B after liver transplantation in Italy: results of a national survey in a large cohort.

Michele Mazzola, Lucio Caccamo, Fausto Zamboni, Riccardo Volpes, Giovanni Vennarecci, Pierluigi Toniutto, Giuseppe Tisone, Mariarosa Tamè, Mauro Salizzoni, Maria R Piras, Guido Piai, Gianpaolo Parrilli, Manuela Merli, Alfredo Marzano, Anna Lotti Suffredini, Rosa M Iemmolo, Giovanni B Gaeta, Paolo Forte, Stefano Fagiuoli, Luciano DE Carlis, Carmine Coppola, Pasquale F Conoscitore, Francesco Caneschi, Patrizia Burra, Patrizia Boccagni, Pietro Andreone

Journal: Minerva gastroenterologica e dietologica 2018;64(1):1-9

PMID: 29307146

Full Text on Minerva Medica View on PubMed

Abstract

BACKGROUND

Prophylaxis of hepatitis B after liver transplantation with antiviral(s) and immunoglobulins efficiently protect the majority of recipients; however recent experiences suggest a decline of HBsAg-positive candidates and the use of hepatitis B Immunoglobulin-free schedules.

METHODS

This national survey evaluated the epidemiology and clinical results of hepatitis B prophylaxis among 10,365 liver transplants performed in 25 years in 13 Italian centers.

RESULTS

With a percentage of 22, 2260 procedures were performed in HBsAg-positive recipients and 714 out of 1080 anti-HBc-positive grafts were used in HBsAg-negative recipients; a total of 2974 patients (29%) were considered at risk of hepatitis B after liver transplantation. Similar rates (18% of HBsAg-positive candidates and 15% of anti-HBc-positive grafts) were registered in the last collected year. Combined prophylaxis with Hepatitis B Immunoglobulins remained prevalent among centers and was effective in 96% of HBsAg-positive recipients and in 94% of HBsAg-negative recipients of anti-HBc-positive grafts.

CONCLUSIONS

Data from this survey confirm: the excellent results of combined prophylaxis; the past and persistent use of Hepatitis B Immunoglobulin-on and only rare -off prophylactic regimens, in contrast with the newest reports; the increasing use of anti-HBc-positive grafts; the past and present high prevalence of HBsAg-positive recipients, due to an increase in candidates with either hepatocellular carcinoma and Hepatitis Delta Virus coinfection in the last years.

Address: Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy.; Department of Medical and Surgical Science, Research Center for the Study of Hepatitis, University of Bologna, Bologna, Italy.; Unit of Hepatobiliary Surgery and Liver Transplant, Department of Surgical Oncological and Gastrointestinal Sciences, Padua University Hospital, Padua, Italy.; Unit of Multivisceral Transplant, Padua University Hospital, Padua, Italy.; Division of Gastroenterology, S. Donato Hospital, Arezzo, Italy.; Unit of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS San Giovanni Rotondo, Foggia, Italy.; Unit of Hepatology and Interventional Ultrasonography, Department of Internal Medicine, OORR Area Stabiese, Plesso Nuovo Gragnano, Naples, Italy.; Department of Surgery and Transplantation, Niguarda Hospital, Milan, Italy.; Unit of Gastroenterology Hepatology and Transplantology, Department of Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.; Division of Gastroenterology, University Hospital Careggi, Florence, Italy.; Department of Internal and Experimental Medicine, Unit of Infectious Diseases, Second University of Naples, Naples, Italy.; Unit of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, University of Modena, Modena, Italy.; Kedrion Biopharma, Lucca, Italy.; Division of Infectious Disease, Vittorio Emanuele II Hospital, Bisceglie, Bari, Italy.; Unit of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.; Gastrointestinal Unit, AOU Sangiovanni di Dio e Ruggi D'Aragona, Salerno, Italy.; Unit of Hepatology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy.; Department of Liver Transplant Coordination, AO Brotzu, Cagliari, Italy.; Unit of General Surgery, Liver Transplantation Center, Città della Salute e della Scienza, University of Turin, Turin, Italy.; Division of Gastroenterology, Department of Medical and Surgical Sciences, AOU Bologna, Bologna, Italy.; Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.; Medical Liver Transplant Section, Department of Medical Sciences Experimental and Clinical, University of Udine, Udine, Italy.; General Surgery and Liver Transplantation San Camillo Hospital, Rome, Italy.; Unit of Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specialità, University of Pittsburgh Medical Center, Palermo, Italy.; Department of General Surgery - Liver, Kidney and Pancreas Transplantation, AO Brotzu, Cagliari, Italy.; Division of Hepato-Biliary-Pancreatic Surgery, IRCCS Ca' Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy - [email protected].

DOI: 10.23736/S1121-421X.17.02407-2

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MeSH Terms: Chemoprevention, Health Care Surveys, Hepatitis B, Hepatitis B Core Antigens, Humans, Italy, Liver Transplantation, Postoperative Complications, Practice Patterns, Physicians', Retrospective Studies, Tissue Donors