High-dose hepatitis B immunoglobulin therapy in hepatocellular carcinoma with hepatitis B virus-DNA/hepatitis B e antigen-positive patients after living donor liver transplantation

Abstract

Aim: To investigate the impact of high-dose hepatitis B immunoglobulin (HBIG) on hepatocellular carcinoma (HCC) and hepatitis B virus (HBV) recurrence and overall survival after living donor liver transplantation (LDLT).

Methods: We investigated 168 patients who underwent LDLT due to HCC, and who were HBV-DNA/hepatitis B e antigen (HBeAg) -positive, from January 2008 to December 2013. After assessing whether the patients met the Milan criteria, they were assigned to the low-dose HBIG group and high-dose HBIG group. Using the propensity score 1:1 matching method, 38 and 18 pairs were defined as adhering to and not adhering to the Milan criteria. For each pair, HCC recurrence, HBV recurrence and overall survival were analyzed by the Kaplan-Meier method and the log rank test according to the HBIG dose.

Results: Among those who met the Milan criteria, the 6-mo, 1-year, and 3-year HCC recurrence-free survival rates were 88.9%, 83.2%, and 83.2% in the low-dose HBIG group and 97.2%, 97.2%, and 97.2% in the high-dose HBIG group, respectively (P = 0.042). In contrast, among those who did not meet the Milan criteria, HCC recurrence did not differ according to the HBIG dose (P = 0.937). Moreover, HBV recurrence and overall survival did not differ according to the HBIG dose among those who met (P = 0.317 and 0.190, respectively) and did not meet (P = 0.350 and 0.987, respectively) the Milan criteria.

Conclusion: High-dose HBIG therapy can reduce HCC recurrence in HBV-DNA/HBeAg-positive patients after LDLT.

Keywords: Hepatitis B e antigen; Hepatitis B immune globulin; Hepatitis B virus-DNA; Hepatocellular carcinoma; Liver transplantation.

Figures

Figure 1

Hepatocellular carcinoma recurrence-free survival rate of the low-dose hepatitis B immunoglobulin group and high-dose hepatitis B immunoglobulin group before adjustment with propensity scores among hepatocellular carcinoma patients who met the Milan criteria (A) and did not meet the Milan criteria (B); hepatitis B recurrence-free survival rate of the low-dose hepatitis B immunoglobulin group group and high-dose hepatitis B immunoglobulin group group before adjustment with propensity scores among hepatocellular carcinoma patients who met the Milan criteria (C) and did not meet the Milan criteria (D). HBIG: Hepatitis B Immunoglobulin; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma.

Figure 2

Overall survival rate of the low-dose hepatitis B immunoglobulin group and high-dose hepatitis B Immunoglobulin group before adjustment with propensity scores among hepatocellular carcinoma patients who met the Milan criteria (A) and did not meet the Milan criteria (B). HBIG: Hepatitis B Immunoglobulin.

Figure 3

Hepatocellular carcinoma recurrence-free survival rate of the low-dose hepatitis B immunoglobulin group and high-dose hepatitis B immunoglobulin group after adjustment with propensity scores among hepatocellular carcinoma patients who met the Milan criteria (A) and did not meet the Milan criteria (B); hepatitis B recurrence-free survival rate of the low-dose hepatitis B immunoglobulin group group and high-dose hepatitis B immunoglobulin group group after adjustment with propensity scores among hepatocellular carcinoma patients who met the Milan criteria (C) and did not meet the Milan criteria (D). HBIG: Hepatitis B Immunoglobulin; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma.

Figure 4

Overall survival rate of the low-dose hepatocellular carcinoma group and high-dose hepatocellular carcinoma group after adjustment with propensity scores among hepatocellular carcinoma patients who met the Milan criteria (A) and did not meet the Milan criteria (B). HBIG: Hepatitis B Immunoglobulin.