Hepatitis B virus prevention strategies for antibody to hepatitis B core antigen-positive liver donation: a survey of North American, European, and Asian-Pacific transplant programs.

Prophylactic therapy is generally used to prevent reactivated hepatitis B after transplantation of an antibody to hepatitis B core antigen (anti-HBc)-positive liver. To gain insight into current practice, a questionnaire was e-mailed to 89 liver transplant physicians in the United States, Europe, and Asia/Australia and 4 hepatitis B experts. Addressees were asked if they prefer lamivudine or other nucleoside analogs and whether these drugs are used indefinitely. They were also questioned about the use of hepatitis B immune globulin (HBIg), the preferred duration of its administration, and whether treatment strategies differ according to the knowledge of the serologic status of the recipient. Responses were obtained from 78 physicians. All transplant physicians reported the use of nucleoside analog therapy, and 65% prefer lamivudine (58% versus 81% for US and non-US physicians, P = 0.05). Sixty-one percent use HBIg (38% always, 23% sometimes). HBIg was used more frequently in the United States than other parts of the world (69% versus 46%, P = 0.03). Eighty-one percent of transplant physicians use nucleoside analog therapy for an indefinite period, but the duration of HBIg treatment varies widely. Although some centers omit nucleoside analog or HBIg therapy in antibody to hepatitis B surface antigen-positive recipients, 90% will not omit these agents if the recipient is positive for anti-HBc alone. In conclusion, nucleoside analog therapy is nearly always used for anti-HBc-positive livers, and most transplant physicians treat for an indefinite period. Lamivudine continues to be preferred as first-line therapy. Many programs also use HBIg, but there is wide variation in the way this is administered. Further study is needed to determine the most cost-beneficial regimen. (c) 2009 AASLD.