As a result, the outcomes of patients with acute and chronic HBV related liver diseases undergoing kinase inhibitor 17-AAG LT are now similar to or better than those with non-HBV related liver transplantation [13], [14]. While the prophylactic therapies in the management of HBV in transplant recipients represent a significant step in LT, there remain controversies and challenges that have not been adequately resolved. Long-term prophylaxis with HBIG is expensive and has been associated with the development of surface antigen mutations. Similarly, emergence of drug resistance caused by tyrosine-methionine-aspartate-aspartate (YMDD) motif mutants occurs with prolonged LAM therapy. The choice of antiviral drugs or drug combinations and duration of prophylaxis are still being debated in the literature.

It has been suggested that short-term rather than life-long HBIG could be used with or without combination of oral nucleos(t)ide analogs in low risk patients [15], [16], [17]. This strategy emphasized the need to identify risk factors capable of predicting hepatitis B relapse after LT for optimal prophylaxis. While several studies have identified clinical predictors such as high viral loads [18], [19], cumulative corticosteroid dose for immunosuppression [20], recurrence of HCC post LT [21], [22], HBIG monoprophylaxis (12) [12] and prolonged LAM therapy [19], [23], none has assessed the predictive roles of the histopathological characteristics in liver explants as well as the genotypic features of the viruses in pre-LT serum samples.

The aim of this study, therefore, was to evaluate the predictive value of all the aforementioned clinicopathological and genotypic virological factors in hepatitis B relapse after LT in patients receiving combination treatment of short-term HBIG and life-long LAM. Methods Ethics statement This study was conducted under the approval of the Institutional Review Board, Chang Gung Memorial Hospital, Taiwan. Written informed consent was obtained from all patients included. Patients Between September 2002 and August 2009, 150 consecutive HBsAg positive patients undergoing LT in Chang Gung Memorial Hospital Linko medical center were included under informed consent. The indications for LT in this group of patients included HCC, decompensated liver diseases and fulminant hepatic failure. All patients were alive more than 3 months after LT and were followed up monthly in the outpatient clinic. This study was approved by the institutional review board at Chang Gung Memorial Hospital. Entinostat HBV prophylaxis protocol Prior to transplantation, LAM (Zeffix, GlaxoSmithKline, Middlesex, UK) (100 mg/day orally) was commenced in 79 patients. Among them, 39 patients received the prophylactic therapy for more than one month.