Prophylactic Use of Low-Dose, On-Demand, Intramuscular Hepatitis B Immunoglobulin and Lamivudine After Liver Transplantation

• Published in: Transplantation proceedings Vol. 38; no. 2; pp. 579 - 583
• Main Authors: Karademir, S., Astarcıoğlu, H., Akarsu, M., Özkardes̨ler, S., Özzeybek, D., Sayıner, A., Akan, M., Tankurt, E., Astarcıoğlu, I.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2006; Elsevier Science
• Subjects: Antiviral Agents - therapeutic use; Biological and medical sciences; DNA, Viral - blood; DNA, Viral - genetics; Drug Administration Schedule; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatitis B - drug therapy; Hepatitis B - surgery; Hepatitis B virus - genetics; Hepatitis B virus - isolation & purification; Human viral diseases; Humans; Immunoglobulins - therapeutic use; Immunosuppressive Agents - therapeutic use; Infectious diseases; Lamivudine - therapeutic use; Liver Failure - surgery; Liver Transplantation; Medical sciences; Recurrence; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology; Viral diseases; Viral hepatitis; Antiretroviral agent; RNA-directed DNA polymerase; Hepatic disease; Transplantation; Homotransplantation; Intramuscular administration; Viral hepatitis B; Prevention; Surgery; Reverse transcriptase inhibitor; Nucleoside analog; Antiviral; Graft; Muscle; Pyrimidine nucleoside; Demand; Immunoglobulins; Enzyme; Transferases; Low dose; Use; Enzyme inhibitor; Lamivudine; Infection; Medicine; Nucleotidyltransferases; Treatment; Dideoxynucleoside; Viral disease; Digestive diseases
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.12.063

The combination of hepatitis B immunoglobulin (HBIG) and antivirals (nucleos[t]ide analogs) has extended the applicability of orthotopic liver transplantation (OLT) for patients with hepatitis B virus (HBV)-related liver disease. However, HBIG administrations have an extremely high cost. Herein, we evaluated our results with low-dose, on-demand, intramuscular HBIG plus lamivudine (LAM) prophylaxis after OLT. The HBV DNA status in 40 patients at the time of OLT determined the treatment: group A (n = 22), HBV DNA (−), no antiviral pretreatment; group B (n = 11), HBV DNA (−), after LAM; group C (n = 3), HBV DNA (+) after LAM (LAM resistance/Adefovir [ADV] unavailable); group D (n = 2), HBV DNA (+), no antiviral pretreatment; and group E (n = 2), HBV DNA (−) after LAM + ADV (LAM resistance/ADV available). Five patients died within 12 months after OLT unrelated to HBV infection. The remaining 35 patients were followed for a median duration of 16 months (range, 6–93 months). Only two recipients from group C, who were transplanted despite LAM resistance + no ADV pretreatment, revealed recurrent HBV infections at 14 and 16 months posttransplantation; they were then treated successfully with ADV as it became available. The third group C recipient had undetectable HBV DNA at 18 months after OLT. The mean cumulative doses of HBIG administered within the first, second, and third years were 34,014, 5258, and 5090 IU, respectively. In conclusion, low-dose, on-demand, intramuscular HBIG plus (LAM ± ADV) prophylaxis is a safe, efficient, and cost-effective regimen to prevent recurrent HBV infection following OLT. OLT despite untreated LAM resistance may require sustained higher serum HBsAb levels after surgery.