Prevention and treatment of new hepatitis B after living donor liver transplantation in children

BACKGROUND: This study aimed to explore the prevention and treatment of new hepatitis B in children after liver transplantation with livers positive for HBcAg and to examine the treatment of new hepatitis B. METHODS: A total of 22 children who received livers positive for HBcAg between January 2013 and December 2015 were retrospectively analyzed. After their operations, the children were given lamivudine for anti-hepatitis B virus (HBV) treatment, a hepatitis B vaccine or intermittent supplements of hepatitis B immunoglobulins to prevent recurrence of the infection, and entecavir for anti-hepatitis B treatment. The children were categorized into two groups: one group of children stopped taking lamivudine one year after operation (n=7) by themselves, while the other group did not (n=15). RESULTS: Of the seven children who stopped lamivudine anti-HBV treatment, six developed hepatitis B at 24.33±13.95 months after operation. Of these children, five were treated with entecavir, resulting in their HBV DNA decreasing to undetectable levels (<50 IU/mL). HBsAg turned negative in four of these patients, but in one patient it did not. The other patient with new hepatitis B continued to use lamivudine, resulting in their HBV DNA decreasing to normal levels (<50 IU/mL) but without their HBsAg turning negative. No new cases of hepatitis B were found in the 15 children who did not stop anti-HBV treatment. CONCLUSIONS: The long-term prophylactic therapy of nucleoside analogues combined with hepatitis B immunoglobulins should be used for a long time after liver transplantation with a liver positive for HBcAg. Discontinuation of nucleoside analogues is associated with a higher risk of the new onset of hepatitis B. Entecavir has a significant effect on the treatment of postoperative new hepatitis B in children.