Post-Liver Transplantation Hepatitis B Prophylaxis in Canada: Results of a National Survey

Chronic hepatitis B remains a significant concern in liver transplantation (LT) due to the risk of graft reinfection. Hepatitis B immunoglobulin (HBIG), combined with nucleos(t)ide analogues (NAs), has been the standard prophylactic approach. However, HBIG-free regimens are emerging, and practices vary across transplant centers. This study aims to describe the current Hepatitis B virus (HBV) prophylaxis policies in Canadian LT programs.

A virtual survey was distributed to all LT centers in Canada through the Canadian Liver Transplant Network. Data on HBIG use, NA selection, monitoring protocols, and recurrence management were collected and analyzed using descriptive statistics.

Nine respondents from 6 Canadian LT centers participated. All centers use HBIG post-transplant, with intramuscular HepaGam B being the most common formulation. HBIG duration varied, with most centers administering it for 6 months to 1 year. Tenofovir was the predominant NA used. HBV recurrence monitoring occurred every 3 months in most centers. Management of recurrence varied, with some centers reinitiating HBIG, while others adjusting NA therapy.

While HBIG and NA combination therapy remains the standard in Canada, significant variations exist in HBIG duration and recurrence management. A growing shift toward HBIG-free regimens in select populations highlights the need for standardized guidelines to optimize post-transplant HBV prophylaxis.