Ortiz-López N, Acevedo M, Vergara T, Roblero JP, Urzúa Á, Cattaneo M, Poniachik J. Dual therapy with nucleos(t)ide analogues in the prevention of hepatitis B virus recurrence after liver transplantation: Two case reports. World J Hepatol 2025; 17(4): 98660 [DOI: 10.4254/wjh.v17.i4.98660]
Corresponding Author of This Article
Jaime Poniachik, MD, Chief Physician, Doctor, Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Carlos Lorca Tobar 999, Independencia, Santiago 8380453, Región Metropolitana, Chile. jponiachik@hcuch.cl
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Hepatol. Apr 27, 2025; 17(4): 98660 Published online Apr 27, 2025. doi: 10.4254/wjh.v17.i4.98660
Dual therapy with nucleos(t)ide analogues in the prevention of hepatitis B virus recurrence after liver transplantation: Two case reports
Nicolás Ortiz-López, Maximiliano Acevedo, Tamara Vergara, Juan Pablo Roblero, Álvaro Urzúa, Máximo Cattaneo, Jaime Poniachik
Nicolás Ortiz-López, Sección de Medicina Interna, Hospital Clínico Universidad de Chile, Santiago 8380453, Región Metropolitana, Chile
Maximiliano Acevedo, Tamara Vergara, Escuela de Medicina, Universidad de Chile, Santiago 8380453, Región Metropolitana, Chile
Juan Pablo Roblero, Álvaro Urzúa, Máximo Cattaneo, Jaime Poniachik, Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago 8380453, Región Metropolitana, Chile
Co-corresponding authors: Máximo Cattaneo and Jaime Poniachik.
Author contributions: Ortiz-López N, Acevedo M, Vergara T, Roblero JP, Urzúa Á, and Cattaneo M contributed to manuscript writing and editing, and data collection; Cattaneo M and Poniachik J contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Efforts were undertaken to contact the patients through all available channels to secure informed consent, yet regrettably, they failed.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jaime Poniachik, MD, Chief Physician, Doctor, Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Carlos Lorca Tobar 999, Independencia, Santiago 8380453, Región Metropolitana, Chile. jponiachik@hcuch.cl
Received: July 2, 2024 Revised: August 31, 2024 Accepted: September 14, 2024 Published online: April 27, 2025 Processing time: 297 Days and 5.3 Hours
Abstract
BACKGROUND
Infection by the hepatitis B virus (HBV) represents a significant global socio-sanitary burden. While liver transplantation (LT) is an important therapeutic option, treatments that prevent HBV reinfection are necessary. The combination of anti-hepatitis B immunoglobulin (HBIG) and nucleoside/nucleotide analogs (NA) is the standard post-transplant treatment; however, there are limitations in using HBIG, particularly its cost. We present two illustrative clinical cases as examples of post-transplant management using dual NA therapy, unaccompanied by HBIG.
CASE SUMMARY
The first case involves a 42-year-old man with HBV-related cirrhosis, who, in the context of a diagnosis of hepatocellular carcinoma and hepatopulmonary syndrome, underwent LT without viremia at the time of transplantation. A lack of availability of HBIG led to the combined use of two NAs, entecavir, and tenofovir alafenamide—resulting in the negativization of hepatitis B surface antigen (HBsAg) and maintenance of a negative viral load in the post-transplant period. In the second case, a 63-year-old woman presented with acute hepatic failure due to HBV with viremia during transplantation. Combined therapy with entecavir and tenofovir alafenamide, again due to the unavailability of HBIG, ultimately led to the negativization of HBsAg and viral load.
CONCLUSION
These cases suggest the efficacy of dual NA therapy in post-transplant HBV management, emphasizing the need to reconsider traditional treatment approaches.
Core Tip: This manuscript explores post-liver transplant strategies for hepatitis B virus (HBV). Two cases showed the success of dual nucleoside/nucleotide analog (NA) therapy (entecavir and tenofovir alafenamide) without hepatitis B immunoglobulin (HBIG) in prevention of HBV recurrence. These cases emphasize the efficacy of dual NA therapy as a viable alternative in managing post-transplant HBV infection, especially when HBIG is unavailable. This challenges the standard protocol and proposes reconsidering post-transplant management when specific treatments are limited.
