Long‐Term Outcomes of Patients Who Receive a Liver Transplant for Hepatitis B With Limited Use of Hepatitis B Immunoglobulin

Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma (HCC). Post-transplant HBV reinfection represents an important post-liver transplantation (LT) complication, which can result in death or graft loss. Hepatitis B immunoglobulin (HBIG) has proven effective in preventing reinfection; however, its high cost and patient inconvenience underscore the need for alternative strategies. In this study, we evaluated the long-term outcomes of HBV-positive LT recipients who received very short-term HBIG immunoprophylaxis combined with life-long antiviral therapy. We conducted a single-center, retrospective cohort study of patients who underwent LT for HBV between 2002 and 2022. Viremic patients received an intraoperative and six consecutive daily doses of HBIG, while non-viremic patients received two doses only post-LT, along with long-term antiviral therapy. The primary outcome was HBV reinfection. Secondary outcomes included death-censored graft survival and overall survival. Seventy-six patients were included. Of these, only three experienced HBV reinfection over the study period. The cumulative incidence of reinfection at 1, 12, 24, and 48 months was observed to be 1.37%, 2.76%, 2.76%, and 2.76%, respectively. The 1-, 3-, and 5-year death-censored graft survival rates were 94%, 94%, and 92%, respectively. The 1-, 3-, and 5-year overall survival rates were 92%, 92%, and 85%, respectively. A very short-term HBIG protocol produced excellent post-transplant outcomes for HBV-positive LT recipients, with very low rates of HBV reinfection and excellent graft and overall survival.