No abstract

dence of active viral replication at the time of transplantation Prophylactic hepatitis B immunoglobulin (HBIg) re-(hepatitis B e antigen [HBeAg]-positive or HBV DNA-posiduces the risk of reinfection in hepatitis B surface antitive by hybridization assay) seem to have the greatest risk gen (HBsAg)-positive liver transplant recipients. In the of recurrent infection. 3,4 Prophylactic hepatitis B immunomedical center of this study, high-dose HBIg immunoglobulin (HBIg) has been shown to reduce the incidence of prophylaxis is administered at a fixed dose of 10,000 IU recurrent HBV infection and improve survival in HBsAg-posmonthly, and in this study, the long-term efficacy of this itive transplant recipients. 5 Previously reported studies have treatment regimen was examined. Of 52 HBsAg-positive used target antibody to HBsAg (anti-HBs) titers to determine liver transplant recipients, 24 were administered HBIg the frequency of HBIg administration. 6-9 Using trough antiimmunoprophylaxis, and 28 were administered no speHBs levels of 100-300 mIU/mL, recurrent HBV infection has cific therapy; the 2-year recurrence rates (defined by the reappearance of HBsAg) were 19% and 76%, respectively. developed in 10%-50% of patients, and rates of reinfection Fifty-four percent of the HBIg-treated patients were pos-may be as high as 80% in patients with indices of active viral itive for HBeAg or hepatitis B virus (HBV) DNA (by hy-replication pretransplantation. 3,[6][7][8][9] The optimal schedule of bridization assay) pretransplantation. In patients ad-HBIg administration is yet to be defined, and the long-term ministered monthly HBIg, intrapatient and interpatient consequences of HBIg administration are unknown. variability in trough antibody to HBsAg (anti-HBs) titerThe HBIg protocol used at our institution provides intravewas significant, highlighting the potential difficulties of nous HBIg daily during the first week posttransplantation using anti-HBs titer to guide therapy. Trough anti-HBs and then on a fixed schedule of 10,000 IU monthly until titers were less in patients who became HBsAg positive recurrence of infection is documented. This regimen offers than in patients who remained HBsAg-negative (490 vs. the advantage of ease of administration and monitoring. This 1290 mIU/mL) (P Å .0001), reflecting either the cause or study focuses on the long-term efficacy and safety of this effect of HBV reinfection. Of 9 patients who remained treatment protocol and seeks to define appropriate treatment HBsAg-negative and who were administered monthly end points.