Cost-effectiveness and long-term outcomes of liver transplantation using hepatitis B core antibody-positive grafts with hepatitis B immunoglobulin prophylaxis in Koreaopen access
- Authors
- Kim, Kyeong Deok; Lee, Ji Eun; Kim, Jong Man; Lee, Okjoo; Hwang, Na Young; Rhu, Jinsoo; Choi, Gyu-Seong; Kim, Kyunga; Joh, Jae-Won
- Issue Date
- Oct-2021
- Publisher
- 대한간학회
- Keywords
- Liver transplantation; Hepatitis B virus; Hepatitis B core antibody; De novo hepatitis B virus; Hepatitis B immunoglobulin
- Citation
- Clinical and Molecular Hepatology, v.27, no.4, pp 603 - 615
- Pages
- 13
- Journal Title
- Clinical and Molecular Hepatology
- Volume
- 27
- Number
- 4
- Start Page
- 603
- End Page
- 615
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/20122
- DOI
- 10.3350/cmh.2021.0137
- ISSN
- 2287-2728
2287-285X
- Abstract
- Background/Aims: Hepatitis B core antibody (anti-HBc)-positive donors are used as an extended donor pool, and current guidelines recommend the usage of nucleos(t)ide analogues (NAs) as prophylaxis for preventing de novo hepatitis B virus infection (DNH). We analyzed the long-term outcomes of a large cohort of liver transplantation (LT) patients receiving anti-HBc-positive grafts and evaluated the risk of DNH when hepatitis B immunoglobulin (HBIG) monotherapy was used as prophylaxis. We also compared the cost-effectiveness of HBIG and NAs. Methods: We retrospectively reviewed 457 patients with anti-HBc-positive grafts and 898 patients with anti-HBcnegative grafts who underwent LT between January 2001 and December 2018. We compared recipient characteristics according to the anti-HBc status of the donor, and compared the costs of using NAs for the rest of the patient's life and using HBIG to maintain hepatitis B surface antibody titers above 200 Ill/L. Results: The 1-, 5-, and 10-year patient survival rates were 87.7%, 73.5%, and 67.7%, respectively, in patients with antiHBc-positive grafts, and 88.5%, 77.4%, and 70.3%, respectively, in patients with anti-HBc-negative grafts (P=0.113). Among 457 recipients with anti-HBc-positive grafts, 117 (25.6%) were non-HBV recipients. The overall incidence of DNH was 0.9%. When using HBIG under insurance coverage, the cumulative cost was lower compared with using NA continuously without insurance coverage in Korea. Conclusions: Anti-HBc-positive grafts alone do not affect patient survival or graft survival. HBIG monoprophylaxis has good outcomes for preventing DNH, and the patient's long-term cost burden is low in Korea because of the national insurance system in this cohort. (Clin Mol Hepatol 2021;27:603-615)
- Files in This Item
- There are no files associated with this item.
- Appears in
Collections - College of Medicine > Department of Radiology > 1. Journal Articles
![qrcode](https://api.qrserver.com/v1/create-qr-code/?size=55x55&data=https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/20122)
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.