Long-term application of human polyclonal hepatitis-B immunoglobulin to prevent hepatic allograft infection. A review of the literature and presentation of five cases.
Liver transplantation has evolved as the therapy of choice in end-stage liver disease. However, liver transplantation for viral liver disease is associated with recurrence of viral hepatitis in the graft. In this paper we discuss the mechanisms of liver cell damage, the clinical impact of recurrent infection and the use of hepatitis-B-specific immunoglobulin (HBIg) to prevent recurrent infection in the allograft. In addition, we propose an HBIg schedule tailored to each individual patient. Based on the excellent survival results published for acute hepatic failure and chronic liver failure with latent hepatitis B virus (HBV) or hepatitis delta infection, we think that no contraindication exists for liver transplantation in these cases. For patients with active viral replication, liver transplantation should only be considered within a scientific frame to prevent reinfection of the allograft.
de Man
R A
RA
Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, Netherlands.
Metselaar
H J
HJ
Heijtink
R A
RA
Schalm
S W
SW
D002908:Chronic Disease; D015897:Comorbidity; D000075202:Contraindications; D004334:Drug Administration Schedule; D005544:Forecasting; D006085:Graft Survival; D006509:Hepatitis B / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D003699:Hepatitis D / Q000453:epidemiology; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D017093:Liver Failure / Q000453:epidemiology / Q000601:surgery*; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin