Efficacy of maintenance subcutaneous hepatitis B immune globulin (HBIG) post-transplant for prophylaxis against hepatitis B recurrence†

Singham, Janakie; Greanya, Erica D.; Lau, Kirby; Erb, Siegfried R.; Partovi, Nilufar; Yoshida, Eric M.

doi:10.1016/s1665-2681(19)31656-4

Cited by 37 publications

(20 citation statements)

References 24 publications

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“…A group from Vancouver switched patients from i.m. to s.c. HBIG to examine the efficacy and patient preference of s.c. administration . They used HBIG in individual frequencies to maintain anti‐HBs levels higher than 100 IU/L.…”

Section: Hepatitis B and Liver Transplantationmentioning

confidence: 99%

Hepatitis B and C in liver transplantation: new strategies to combat the enemies

Beckebaum

Kabar

Cicinnati

2012

Reviews in Medical Virology

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Hepatitis B immune globulin-free therapeutic regimens with a nucleos(t)ide analogue (NUC) or NUC combinations after liver transplantation (LT) are currently being investigated for their efficacy and safety as HBV re-infection prophylaxis in clinical studies. Recurrence rates differ among these studies as most of them are limited by a non-randomised study design, small sample size, lack of long-term data and varying time intervals for the switch from combined to purely virostatic prophylaxis. Post-transplant pre-emptive antiviral therapy with pegylated IFN and ribavirin is associated with low sustained virological response rates and was found to have no advantage over treatment of manifest HCV re-infection. Safety and efficacy of triple antiviral therapy including boceprevir or telaprevir in patients with manifest HCV re-infection are currently under investigation in clinical trials. Relevant drug interactions have been shown to occur during calcineurin inhibitor (CNI) and concomitant triple antiviral therapy, which vary with type of CNI and choice of HCV protease inhibitor. Newer direct-acting antivirals with lower or minimal toxicity, when used in combination with immunosuppressives, are worthy of further study in LT patients. This review focuses on hot topics in the management of hepatitis B and C patients before and after LT and offers a critical summarised selection of the corresponding relevant studies published in the current literature or presented at recent liver congresses.

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Section: Hepatitis B and Liver Transplantationmentioning

confidence: 99%

Hepatitis B and C in liver transplantation: new strategies to combat the enemies

Beckebaum

Kabar

Cicinnati

2012

Reviews in Medical Virology

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“…Both studies suggested SC delivery of HBIg as an alternative when IM or IV dosing are not possible [55][56]. The benefits of SC administration of HBIg include the potential for self-administration by patients, lower dosage (500-1000 IU), few adverse drug effects, stability of anti-HB levels, and an especially low recurrence rate [21][54][55][56]. …”

Section: Resultsmentioning

confidence: 99%

Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

Dindoost

Jazayeri

Alavian³

2012

Hepat Mon

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ContextLiver transplantation is the best treatment option for end-stage liver disease following hepatitis B (HBV) infection. However, the high rate of recurrence of HBV infection following transplantation is a disadvantage of this option.Evidence AcquisitionOver the past 2 decades, the gold standard of prophylactic treatment for the prevention of HBV re-infection following liver transplantation has been the administration of low- to high-dose hepatitis B immune globulin (HBIg) along with an antiviral agent to induce passive immunity.ResultsThe effectiveness of HBIg in preventing the recurrence of HBV depends on the dosage, route of administration, and duration of HBIg treatment, and the viremic status at the time of transplantation. There is currently no consensus on a standardized recommendation for therapeutic options that include HBIg administration.ConclusionThis review attempts to summarize the available data on the feasibility of such options. Most recent studies support the use of long-term combination therapy of HBIg and antiviral NAs (especially new agents).

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“…More recently, subcutaneous (SC) regimens of HBIG have proven effective as well, and they have some advantages in tolerability and patient satisfaction in comparison with IM administration 24. These injections can be administered in a clinic by trained personnel, and even self‐administration at home has been proven safe and effective in a phase 3 trial 25.…”

Section: Hbvmentioning

confidence: 99%

Immunoprophylaxis against and prevention of recurrent viral hepatitis after liver transplantation

Laryea

Watt

2012

Liver Transpl

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The reinfection of the hepatic allograft with hepatitis B virus and hepatitis C virus can have important sequelae that result in poor long-term patient and graft survival. Although a response to treatment with antiviral medications can improve these outcomes, not all patients tolerate these medications or experience viral eradication. Avoiding reinfection of the graft is the most effective means of improving the long-term outcomes for these patient populations. This review is focused on the prevention of viral hepatitis reinfection after liver transplantation. Liver Transpl 18:514-523, 2012. V C 2012 AASLD.Received July 2, 2011; accepted February 2, 2012.Although recurrent disease after liver transplantation (LT) can occur with most indications for LT, it is a particular issue with viral hepatitis. The dampening of immune mechanisms by immunosuppression can lead to the recurrence of chronic viral hepatitis from hepatitis B virus (HBV) or hepatitis C virus (HCV) in the graft and can alter its natural history significantly. In fact, an untreated graft reinfection can lead to the rapid progression of fibrosis and early graft loss. The timing and natural history of recurrent viral hepatitis after transplantation can vary according to number of factors, including surgical factors and donor or recipient factors. The treatment of recurrent disease can be more problematic (more so with HCV) in transplant patients versus nontransplant patients because of decreased efficacy and potentially increased side effects. The impact of recurrent disease on overall patient and graft survival can be reduced by the understanding and prevention of recurrent viral hepatitis. This review outlines the progress in prophylaxis focused on reducing the recurrence of HBV and HCV after LT, and it underscores the areas in need of further investigation so that the effects of recurrent disease on posttransplant outcomes can be reduced. HBVThe first experiences with LT for HBV-related disease were marred by high rates of graft failure and patient mortality due to aggressive recurrent disease. These poor outcomes compelled some centers to declare a moratorium on LT for HBV-related disease. Advances in the prevention and treatment of recurrent disease after LT have resulted in overall survival rates now as high as 90% at 5 years, 1 and they have made HBV-related liver disease an acceptable indication for LT worldwide. With appropriate prophylaxis and proper patient adherence, recurrence rates are now consistently less than 10%. Recurrent HBV after transplantation is due to a failure Abbreviations: ADV, adefovir dipivoxil; anti-HBc, antibody to hepatitis B core antigen; anti-HBs, antibody to hepatitis B surface

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Efficacy of maintenance subcutaneous hepatitis B immune globulin (HBIG) post-transplant for prophylaxis against hepatitis B recurrence†

Cited by 37 publications

References 24 publications

Hepatitis B and C in liver transplantation: new strategies to combat the enemies

Hepatitis B and C in liver transplantation: new strategies to combat the enemies

Hepatitis B Immune Globulin in Liver Transplantation Prophylaxis: An Update

Immunoprophylaxis against and prevention of recurrent viral hepatitis after liver transplantation

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