Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3803-3812
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3803
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
Eung Chang Lee, Seong Hoon Kim, Seung Duk Lee, Hyeongmin Park, Soon-Ae Lee, Sang-Jae Park
Eung Chang Lee, Seong Hoon Kim, Seung Duk Lee, Hyeongmin Park, Soon-Ae Lee, Sang-Jae Park, Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do 410-769, South Korea
Author contributions: Lee EC, Kim SH, Lee SD, Park H, Lee SA and Park SJ designed the research; Lee EC, Lee SD, Park H performed the research and analyzed the data; Lee EC wrote the paper; Kim SH supervised the study and revised the paper.
Institutional review board statement: This study was approved by the Institutional Review Board of National Cancer Center, Republic of Korea.
Informed consent statement: We obtained a waiver of informed consent with the Institutional Review Board of our center.
Conflict-of-interest statement: No conflicts of interest were declared for all authors.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at kshlj@ncc.re.kr. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seong Hoon Kim, MD, PhD, Center for Liver Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, South Korea. kshlj@ncc.re.kr
Telephone: +82-31-9201647 Fax: +82-31-9201138
Received: November 9, 2015
Peer-review started: November 10, 2015
First decision: November 27, 2015
Revised: December 13, 2015
Accepted: January 9, 2016
Article in press: January 11, 2016
Published online: April 14, 2016
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 immune globulin, Hepatocellular carcinoma, Hepatitis B virus-DNA, Liver transplantation, Hepatitis B e antigen

Core tip: This is a single center analysis of the effects of high-dose hepatitis B immunoglobulin (HBIG) therapy on the recurrence of hepatocellular carcinoma and hepatitis B in hepatitis B virus (HBV)-DNA/hepatitis B e antigen (HBeAg)-positive patients after LDLT. High-dose HBIG therapy can be helpful in improving hepatocellular carcinoma recurrence-free survival in HBV-DNA/HBeAg-positive recipients who met the Milan criteria. In contrast, high-dose HBIG therapy was not effective in improving HCC recurrence-free survival in HBV-DNA/HBeAg-positive recipients who did not meet the Milan criteria. Recurrence of hepatitis B and overall survival were not affected by the HBIG dose in HBV-DNA/HBeAg-positive recipients regardless of the Milan status.