Oral Nucleos(t)ide Analogs Alone After Liver Transplantation in Chronic Hepatitis B With Preexisting rt204 Mutation

Transplantation. 2017 Oct;101(10):2391-2398. doi: 10.1097/TP.0000000000001883.


Background: There is currently limited data regarding the use of oral antiviral therapy alone without hepatitis B immune globulin for chronic hepatitis B patients with preexisting lamivudine (LAM) resistance (LAM-R) undergoing liver transplantation.

Methods: This is a cohort study determining the effectiveness and long-term outcome in this group of patients.

Results: Fifty-seven consecutive chronic hepatitis B patients with preexisting rt204 LAM-R mutations or virological load refractory to LAM undergoing liver transplantation were included, with a median follow-up of 73 months. Fifty-five (96.5%) patients received a regimen that included the use of nucleotide analogs. The cumulative rate of hepatitis B surface antigen seroclearance at 1, 5, and 10 years was 82%, 88%, and 91%, respectively. At the time of transplantation, 39 (72%) patients had detectable hepatitis B virus (HBV) DNA, with a median of 4.5 log copies/mL. The cumulative rate of HBV undetectability was 91% at 1 year, increasing to 100% by 5 years. After 1 year of liver transplantation, over 90% of the patients had undetectable HBV DNA, and from 8 years onward, 100% had undetectable HBV DNA. The overall long-term survival was excellent, with a 12-year survival of 87%. There was no HBV-related graft loss, and no retransplantation or deaths due to HBV reactivation.

Conclusion: Oral antiviral therapy alone without hepatitis B immune globulin is highly effective in preventing HBV reactivation and graft loss from recurrent hepatitis B after liver transplantation in patients with preexisting LAM resistance HBV. The long-term outcome was excellent, with survival of 87% at 12 years after transplantation, without any mortality related to HBV reactivation.

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / adverse effects
  • DNA, Viral / genetics
  • Drug Administration Schedule
  • Drug Resistance, Viral / genetics*
  • End Stage Liver Disease / diagnosis
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / surgery*
  • End Stage Liver Disease / virology
  • Female
  • Genotype
  • Graft Survival / drug effects
  • Hepatitis B virus / drug effects*
  • Hepatitis B virus / genetics
  • Hepatitis B, Chronic / diagnosis
  • Hepatitis B, Chronic / drug therapy*
  • Hepatitis B, Chronic / mortality
  • Hepatitis B, Chronic / virology
  • Humans
  • Kaplan-Meier Estimate
  • Lamivudine / administration & dosage*
  • Liver Transplantation* / adverse effects
  • Liver Transplantation* / mortality
  • Male
  • Middle Aged
  • Mutation*
  • Nucleosides / administration & dosage*
  • Nucleosides / adverse effects
  • Nucleotides / administration & dosage*
  • Nucleotides / adverse effects
  • Recurrence
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Viral Load
  • Virus Activation / drug effects


  • Antiviral Agents
  • DNA, Viral
  • Nucleosides
  • Nucleotides
  • Lamivudine