Human polyclonal anti-hepatitis B surface antigen immunoglobulin reduces the frequency of acute rejection after liver transplantation for chronic hepatitis B

Abstract

SUMMARYBackground: Use of polyclonal anti-hepatitis B surface antigen immunoglobulin (HBIg) has been shown to reduce hepatitis B virus (HBV) recurrence after liver transplantation (LT) and to decrease the frequency of acute cellular rejection (ACR). However, the protective role of HBIg against ACR remains controversial, since HBV infection has been also associated with a lower incidence of ACR. Aim: To assess the relationship between HBIg immunoprophylaxis and the incidence of rejection after LT. Methods: 260 patients (158 males, 43 ± 14 years old) submitted to LT were retrospectively evaluated and divided into three groups, according to the presence of HBsAg and the use of HBIg. Group I was comprised of HBsAg-positive patients (n = 12) that received HBIg for more than 6 months. Group II was comprised of HBsAg-positive patients that historically have not received HBIg or have been treated irregularly for less than 3 months (n = 10). Group III was composed of 238 HBsAg-negative subjects that have not received HBIg. Results: HBIg-treated patients (group I) had significantly less ACR episodes, when compared to group II and III. No differences between groups II and III were observed. Conclusions: Long-term HBIg administration contributes independently to reduce the number of ACR episodes after LT.

Low incidence of acute rejection in hepatitis B virus positive liver transplant recipients and the impact of hepatitis B immunoglobulin

“…Our results confirm previous studies that have reported a low incidence of ACR following LT for HBV in the 1980s–90s, although mechanisms for this association have not been fully elucidated [8,10]. Chronic HBV infection is the result of an inadequate immune response towards the virus.…”

Entecavir and hepatitis B immune globulin in patients undergoing liver transplantation for chronic hepatitis B

“…Among the 24 patients who had evidence of HCC in the liver at the time of transplant, only 1 patient (4.2%) had established HCC recurrence. The observed rate of liver rejection in the present study (27.7%) is comparable to the rate reported elsewhere for combined NUC and HBIG therapy . Five patients died during the study.…”

“…The observed rate of liver rejection in the present study (27.7%) is comparable to the rate reported elsewhere for combined NUC and HBIG therapy. 30 Five patients died during the study. No death was considered related to the study treatment.…”

Hepatitis B Immunoglobulins Inhibit Dendritic Cells and T Cells and Protect Against Acute Rejection After Liver Transplantation

“…It is unknown whether IVIG are effective as prophylaxis for acute rejection after organ transplantation. In support of this possibility, two papers have reported that treatment of liver graft recipients with anti-HBs Ig or anti-CMV Ig protects against acute rejection (7,8), but a study from another liver transplant center failed to confirm this protective action (9).…”