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ON-DEMAND LOW-DOSE HEPATITIS B IMMUNOGLOBULIN WITH ANTIVIRAL THERAPY IS EFFECTIVE PROPHYLAXIS POST LIVER TRANSPLANT FOR HEPATITIS B
N Sarin, P Myers, PJ Marotta
Liver Transplant Unit, University Campus, London Health Sciences Centre, University of Western Ontario, London, Ontario
BACKGROUND: Antiviral therapy and Hepatitis B Immunoglobulin (HBIG) are effective ways to decrease Hepatitis B virus (HBV) recurrence post liver transplant (LT). Original studies used high cumulative doses of HBIG which is associated with enormous costs.
AIM: To assess effectiveness and cost-savings associated with low-dose HBIG in LT patients who are hepatitis B surface antigen (HBsAg) positive.
METHODS: 16 HBsAg patients underwent LT. The low-dose protocol was employed from 2002 to present. All patients received 10000 IU HBIG IV during the anhepatic phase, with 10000 IU HBIG IV × 7 days following transplant, and 2000 IU HBIG IM when HBsAb <125 mIU/mL, with levels checked monthly. If HBsAb < 50 mIU/mL or HBsAg became positive, then re-induction with HBIG 5000 IU IV monthly × 2 injections was permitted.
RESULTS: All 16 patients were treated with HBIG in addition to continuous use of an oral agent. Treatment was well tolerated with no serious side effects. The mean follow-up was 36 months (3 – 67), with a total of 46.4 patient years of follow-up. 3 patients became surface antigen (sAg) positive, all had sub-therapeutic sAb levels. 1 had recurrent metastatic HCC treated palliatively and was HBVDNA positive. 2 others had re-induction and became HBsAg negative, HBsAb positive, and remained HBVDNA negative throughout. Thus at most recent follow-up 15/16 remain sAg negative indicating effectiveness of low-dose HBIG of 94%. The average monthly dose of IM HBIG in our protocol was 680 IU compared to 10000 IU IV in conventional protocols, leading to a savings of $91 000/year/pateint.
CONCLUSION: On-demand low-dose HBIG is extremely effective with concomitant antiviral therapy in preventing Hepatitis B recurrence post-LT in HBsAg positive patients, and is associated with enormous cost savings.