***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Hepatitis B virus ( HBV ) recurrence rates of 0 - 16 % had been reported in patients maintained on nucleoside analogues ( NA ) after hepatitis B immunoglobulin ( HBIG ) discontinuation after orthotopic liver transplantation ( OLT ) . However , follow-up in most studies was short . We aim ed to determine the long-term risk of HBV recurrence using this strategy . All HBV patients who received > or = 7 doses of intravenous HBIG after OLT , with no HBV recurrence while receiving HBIG , and who eventually discontinued HBIG and were maintained on NA , were included .  HBV recurrence was defined as HBsAg-positive or HBV DNA > or = 5 log copies/mL on 2 consecutive occasions . Twenty-one patients met the inclusion criteria . Immediate post-OLT prophylaxis was combination HBIG and NA in 15 patients , whereas 6 patients received HBIG monotherapy for 62 - 109 months before NA was added . HBIG was discontinued a median of 26 ( range , 0.2 - 121 ) months after OLT . Median follow-up post-HBIG discontinuation was 40 ( range , 5 - 51 ) months . Only 1 patient , who had 12 months of HBIG and was noncompliant to NA therapy , had HBV recurrence , 34 months after HBIG discontinuation . One patient had HBV DNA of 3.3 log copies/mL 47 and 48 months after HBIG discontinuation but remained HBsAg-negative . Lamivudine-resistant mutations were detected in both patients . Probability of HBV recurrence was 0 % and 9 % at 2 and 4 years after HBIG discontinuation . Three patients had 1 - 2 episodes of transiently detectable HBV DNA . All were HBV DNA and HBsAg negative on repeated tests over a period of 2 - 36 months . Maintenance therapy with NA after discontinuation of long-term HBIG therapy is associated with a low risk of HBV recurrence after OLT in compliant HBV patients Hepatitis B immunoglobulin ( HBIg ) and lamivudine combination has been accepted as the best way to control hepatitis B recurrence after liver transplantation . However , the optimal dose of HBIg and the target titer of hepatitis B surface antibody ( HBsAb ) remain unclear . We report our satisfactory experience with high-dose HBIg in the early period followed by low-dose HBIg with lamivudine . Subjects comprised five patients with fulminant hepatitis ( FH ) and 18 patients with liver cirrhosis ( LC ) who underwent liver transplantation .  HBIg at a dosage of 200 IU/kg per day was administered for one week postoperatively . Thereafter , HBIg was administered only for HBsAb titer < 100 IU/L. After six months , HBIg was withdrawn in FH and administered in LC only for HBsAb titer < 10 IU/L. Lamivudine was administered to two FH and all LC cases . Although two patients with LC showed transient hepatitis B surface antigen ( HBsAg ) recurrence , all patients remained HBsAg-negative at the final follow-up date . This method allows reliable and cost-effective control of hepatitis B recurrence OBJECTIVE : Although hepatitis B recurrence after liver transplantation has been reduced to 0%–10 % since the application of the combination therapy of hepatitis B immunoglobulin ( HBIG ) and lamivudine , the viral mutation resistance of lamivudine is still an obstacle to the outcome of liver transplantation . Here we evaluate the role of entecavir in preventing hepatitis B recurrence after liver transplantation Prior to effective prophylaxis , liver transplantation for hepatitis B virus (HBV)‐related disease was frequently complicated by recurrence , which could be severe and rapidly progressive . Combination hepatitis B immunoglobulin ( HBIG ) and lamivudine prophylaxis reduces this rate of recurrence to < 5 % at 5 years ; however , HBIG administration is costly and inconvenient . We conducted a multicenter r and omized study of adefovir dipivoxil substitution for low‐dose intramuscular ( IM ) HBIG in patients without HBV recurrence at least 12 months posttransplantation for HBV‐related disease . Thirty‐four patients were r and omized , 16 to adefovir  ( 1 patient withdrew consent at 3 months and is not considered in the results ) and 18 to continue HBIG . All continued lamivudine . Groups were well matched by age , sex , and time since transplantation ( median , 4.5 years ) , and background virological risk for HBV recurrence ( 30 % of patients in the adefovir group , 24 % in the HBIG group having detectable HBV DNA at transplantation ) . All patients were alive at study completion without recurrence . One patient in the adefovir group became hepatitis B surface antigen – positive at 5 months but was persistently HBV DNA undetectable via polymerase chain reaction ( sensitivity 14 IU/mL ) over the following 20 months . Median creatinine was not significantly changed over the course of the study in either group . One patient in the adefovir group with a background of diabetic and hypertensive nephropathy ( baseline creatinine 150 μmol/L ) developed increased creatinine leading to dose reduction and ultimately cessation of adefovir at 15 months . Yearly cost of combination adefovir/lamivudine prophylaxis was $ 8,290 versus $ 13,718 IM HBIG/lamivudine . Conclusion : Compared with combination HBIG plus lamivudine prophylaxis , combination adefovir plus lamivudine provides equivalent protection against recurrent HBV infection but with better tolerability and less cost . ( HEPATOLOGY 2008 . Liver transplant recipients are at risk of developing recurrent hepatitis B after liver transplantation for hepatitis B virus (HBV)‐related liver disease . We evaluated the efficacy of a new hepatitis B prophylaxis regimen involving conversion from at least 12 months of HBIg with lamivudine to combination therapy with an oral nucleoside and nucleotide analog . Between June 2008 and May 2010 , a total of 61 liver transplant recipients were converted to a combination of a nucleoside and nucleotide analog . The mean ( ±st and ard deviation ) follow‐up time after conversion was 15.0 ( ±6.1 ) months . Recurrent HBV occurred in two ( 3.3 % ) patients at 3.1 and 16.6 months after HBIg cessation . The overall person time incidence rate for HBV recurrence after HBIg cessation was 2.7 cases per 100 person‐years . The estimate of HBV recurrence was 1.7 % at 1 year after HBIg cessation . HBIg cessation a minimum of 12 months after liver transplantation with subsequent combination therapy with a nucleoside and nucleotide analog  provides effective prophylaxis against recurrent HBV infection . The clinical implication s of HBsAg detection without clinical , biochemical or molecular manifestations of recurrent hepatitis B require further study Immunoprophylaxis using intravenous ( IV ) hepatitis B immune globulin ( HBIG ) decreases the recurrence of hepatitis B virus ( HBV ) infection after orthotopic liver transplantation ( OLT ) . However , IV HBIG is expensive , has significant side effects , and is inconvenient to administer . An alternative approach for prophylaxis using intramuscular ( IM ) HBIG and oral lamivudine was prospect ively evaluated in this study . Ten consecutive patients with cirrhosis with HBV infection who underwent OLT were included in this study . Nine of 10 patients received lamivudine , 150 mg/d , for an average duration of 8.6 months before OLT . Two of 10 patients with detectable HBV DNA at the time of OLT received 10,000 U ( 45 mL ) of IV HBIG daily for 7 consecutive days , followed by 5 mL of IM HBIG weekly for the next 3 weeks , then every 3 weeks . The other 8 patients were HBV DNA negative at OLT and received one dose of IV HBIG ( 45 mL ) during surgery , followed by 5 mL of IM HBIG weekly for 4 weeks , then every 3 weeks . All patients received lamivudine , 150 mg/d , after OLT . During a mean follow-up of 15.6 months , 9 of 10 patients achieved a protective hepatitis B surface antibody ( HBsAb ) titer greater than 200 IU/L and had no evidence of HBV recurrence . One patient failed to develop an adequate HBsAb titer and developed histological and virological evidence of recurrence . One patient died unrelated to HBV recurrence . Our preliminary data suggest that this combination prophylaxis with IM HBIG and lamivudine is effective and potentially cost saving Recurrence of hepatitis B impairs the outcome of liver transplantation ( OLT ) . In serum hepatitis B virus (HBV)-DNA-positive recipients , prophylaxis using lamivudine and immunoglobulins ( HBIg ) reduces the risk of recurrence , but it is undefined whether this regimen also protects c and i date s with YMDD mutants . Seventeen OLT viraemic c and i date s received  pre-emptive lamivudine followed by post-OLT prophylaxis with lamivudine and HBIg . Both sera and liver biopsies were prospect ively collected and high-sensitive polymerase chain reaction ( PCR ) assay was applied for HBV-DNA detection . Finally , the presence of YMDD mutants was explored in all PCR-positive sample s. All patients remained hepatitis B recurrence-free after a mean follow up of 32 months . By PCR , serum HBV-DNA was detectable in 64.3 % of cases at OLT-baseline , in 64.7 % under combined prophylaxis and in 58.8 % in patients ( 70.5 % of the total ) with a minimum follow up of 24 months . At OLT-baseline , YMDD mutants were found in 44.4 % of patients . After OLT , mutants were present in 50 % of patients but only in 16.6 % of cases in the long period . Although 41 % of the native livers and 42.8 % of the analysed grafts harboured HBV-DNA , YMDD mutants were detected in 57 % of the native positive livers . YMDD mutants were largely detected both at OLT-baseline and post-OLT , but their presence decreased over time . Regardless of the presence of YMDD mutants , no hepatitis B recurrence was observed in our OLT recipients using pre-emptive lamivudine  followed by continuous prophylaxis with lamivudine and HBIg 
    Output:
    
Our findings favor the use of HBIG and a hgbNA instead of HBIG and LAM combined prophylaxis against HBV recurrence after LT