Evaluation of hepatitis B recurrence in liver transplant recipients in Vietnam

Abstract

Introduction

: Hepatitis B virus (HBV) is a global public health challenge and a leading cause of end – stage liver disease requiring transplantation. However, HBV recurrence after transplantation can significantly compromise graft function and patient survival. In the context of limited healthcare resources, evaluating the recurrence rate and the current status of prophylactic strategies is essential.

Methods

: A cross-sectional descriptive study was conducted at the 108 Military Central Hospital (Vietnam) involving 126 patients who underwent LT due to HBV-related liver diseases. Data collected included pre- and post-transplant laboratory results (HBsAg, HBeAg, Anti-HBs, Anti-HBc IgG/IgM, and HBV-DNA) and information regarding prophylactic regimens (use of Hepatitis B Immunoglobulin [HBIG] and nucleos(t)ide analog [NA]).

Results

: Male patients accounted for 89.7 %, with a mean age of 54.2 ± 10.8 years. The average follow-up duration after transplantation was 34.4 ± 20.1 months. HCC was the most common indication for LT (48.4 %). The HBV recurrence rate was 11.1 %. Short-term HBIG prophylaxis following transplantation, in combination with long-term NA therapy, has demonstrated effectiveness in preventing HBV recurrence in this patient population. Notably, only 25.4 % of patients were Anti-HBs positive, raising concerns about long-term immunological protection. The use of appropriately dosed HBIG in combination therapy, tailored according to high- and low-risk HBV recurrence groups, should be considered to optimize antibody levels in this patient population, as maintaining HBIG therapy remains a major challenge due to financial burden and supply shortages in Vietnam.

Conclusion

: Oral NA therapy remains an effective prophylactic approach for preventing HBV recurrence after LT, particularly in the context of significant challenges associated with HBIG availability in Vietnam. Strategies to enhance post-transplant Anti-HBs titers – such as selective dosing of HBIG administration – should be considered in long-term post-transplant care.