Evaluation of Italian clinical practice for preventing HBV recurrence post-LT: a Delphi panel study

Area of Science:

• Hepatology
• Virology
• Transplantation Medicine

Background:

• Hepatitis B immunoglobulin (HBIG) and high-barrier nucleos(t)ide analogues (hbNUCs) are standard for preventing hepatitis B virus (HBV) recurrence after liver transplantation (LT).
• Italian clinical practices for HBV prophylaxis post-LT exhibit heterogeneity in HBIG management and patient selection for specific regimens.
• A modified Delphi panel was conducted to assess current Italian practices, focusing on risk stratification and HBIG use.

Purpose of the Study:

• To characterize current Italian expert practices for HBV prophylaxis following liver transplantation.
• To identify patient risk factors for HBV recurrence and guide HBIG management strategies.
• To explore consensus on HBIG dosage, administration, and prophylaxis duration.

Main Methods:

• A modified Delphi panel involving sixteen Italian experts from the EPAteam network.
• A 35-item online survey was administered across three rounds to gather expert opinions.
• A final in-person meeting was held to discuss survey results and controversial topics.

Main Results:

• Agreement was reached that hbNUCs and HBIG combination is the standard HBV prophylaxis post-LT.
• Patients with HBV-DNA >20,000 IU/mL at LT or with hepatitis D virus (HDV) coinfection were identified as high-risk, warranting lifelong HBIG.
• No consensus was achieved on optimal prophylaxis duration for low-risk patients or specific HBIG dosing/intervals; subcutaneous HBIG was preferred for specific patient groups.

Conclusions:

• The lifelong combination of HBIG and NUCs is confirmed as the gold standard for HBV prophylaxis post-LT.
• Significant variability in clinical practice persists, particularly for low-risk patients.
• Prophylactic strategies are often individualized based on patient characteristics rather than standardized protocols.