ORIGINAL ARTICLE   

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

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

Copyright © 2017 EDIZIONI MINERVA MEDICA

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