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Minerva Gastroenterologica e Dietologica 2018 March;64(1):1-9

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


language: English

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

Alfredo MARZANO 1, Pietro ANDREONE 2, Patrizia BOCCAGNI 3, Patrizia BURRA 4, Francesco CANESCHI 5, Pasquale F. CONOSCITORE 6, Carmine COPPOLA 7, Luciano DE CARLIS 8, Stefano FAGIUOLI 9, Paolo FORTE 10, Giovanni B. GAETA 11, Rosa M. IEMMOLO 12, Anna LOTTI SUFFREDINI 13, Michele MAZZOLA 14, Manuela MERLI 15, Gianpaolo PARRILLI 16, Guido PIAI 17, Maria R. PIRAS 18, Mauro SALIZZONI 19, Mariarosa TAMÈ 20, Giuseppe TISONE 21, Pierluigi TONIUTTO 22, Giovanni VENNARECCI 23, Riccardo VOLPES 24, Fausto ZAMBONI 25, Lucio CACCAMO 26 , ISPHeB group 

1 Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy; 2 Department of Medical and Surgical Science, Research Center for the Study of Hepatitis, University of Bologna, Bologna, Italy; 3 Unit of Hepatobiliary Surgery and Liver Transplant, Department of Surgical Oncological and Gastrointestinal Sciences, Padua University Hospital, Padua, Italy; 4 Unit of Multivisceral Transplant, Padua University Hospital, Padua, Italy; 5 Division of Gastroenterology, S. Donato Hospital, Arezzo, Italy; 6 Unit of Gastroenterology, “Casa Sollievo della Sofferenza” Hospital, IRCCS San Giovanni Rotondo, Foggia, Italy; 7 Unit of Hepatology and Interventional Ultrasonography, Department of Internal Medicine, OORR Area Stabiese, Plesso Nuovo Gragnano, Naples, Italy; 8 Department of Surgery and Transplantation, Niguarda Hospital, Milan, Italy; 9 Unit of Gastroenterology Hepatology and Transplantology, Department of Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy; 10 Division of Gastroenterology, University Hospital Careggi, Florence, Italy; 11 Department of Internal and Experimental Medicine, Unit of Infectious Diseases, Second University of Naples, Naples, Italy; 12 Unit of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, University of Modena, Modena, Italy; 13 Kedrion Biopharma, Lucca, Italy; 14 Division of Infectious Disease, Vittorio Emanuele II Hospital, Bisceglie, Bari, Italy; 15 Unit of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy; 16 Gastrointestinal Unit, AOU Sangiovanni di Dio e Ruggi D’Aragona, Salerno, Italy; 17 Unit of Hepatology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy; 18 Department of Liver Transplant Coordination, AO Brotzu, Cagliari, Italy; 19 Unit of General Surgery, Liver Transplantation Center, Città della Salute e della Scienza, University of Turin, Turin, Italy; 20 Division of Gastroenterology, Department of Medical and Surgical Sciences, AOU Bologna, Bologna, Italy; 21 Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy; 22 Medical Liver Transplant Section, Department of Medical Sciences Experimental and Clinical, University of Udine, Udine, Italy; 23 General Surgery and Liver Transplantation San Camillo Hospital, Rome, Italy; 24 Unit of Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specialità, University of Pittsburgh Medical Center, Palermo, Italy; 25 Department of General Surgery - Liver, Kidney and Pancreas Transplantation, AO Brotzu, Cagliari, Italy; 26 Division of Hepato-Biliary-Pancreatic Surgery, IRCCS Ca’ Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy


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.

KEY WORDS: Hepatitis B virus - Liver transplantation - Immunoglobulins

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