Improved outcome of orthotopic liver transplantation for chronic hepatitis B cirrhosis with aggressive passive immunization.
Passive immunization with hepatitis B surface antibody (anti-HBs) is important to prevent hepatitis B virus (HBV) recurrence after orthotopic liver transplantation for chronic HBV cirrhosis. Hepatitis B immune globulin (HBIG) dosing regimens have been poorly defined, utilize numerous routes of administration, and result in a high rate of HBV relapse and mortality. Twenty-five of 27 (93%) patients transplanted (four retransplants) for chronic HBV cirrhosis show no evidence of recurrent HBV (range, 2-55 months). Anti-HBs titers necessary to minimize the risk of hepatitis B surface antigen detectability were >500 IU/L for days 0 to 7, >250 IU/L for days 8 to 90, and >100 IU/L thereafter. Pretransplant HBV E antigen (HBeAG)-positive patients required more HBIG to achieve these goals than HBeAG-negative individuals. The elimination of anti-HBs changed continually for the initial 3 posttransplant months. The anti-HBs half-life increased from 0.7 days to 14.1 days. Anti-HBs elimination was significantly different in HBeAG+ and HBeAG- patients for the first week, but was subsequently indistinguishable after week 1. After 3 months, the half-life was statistically less for HBeAG+ patients, but the difference did not influence the clinical treatment regimens. Quantitative hepatitis B DNA levels did not predict the amount of HBIG required. HBV recurrence after orthotopic liver transplantation can be reduced by aggressive passive immunization. Pharmacokinetic analysis of anti-Hbs elimination can improve immunoglobulin therapy and prevent recurrence of clinical hepatitis.
McGory
R W
RW
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Ishitani
M B
MB
Oliveira
W M
WM
Stevenson
W C
WC
McCullough
C S
CS
Dickson
R C
RC
Caldwell
S H
SH
Pruett
T L
TL
D000328:Adult; D002908:Chronic Disease; D005260:Female; D006509:Hepatitis B / Q000601:surgery*; D006510:Hepatitis B Antibodies / Q000627:therapeutic use; D006513:Hepatitis B e Antigens / Q000378:metabolism; D006801:Humans; D007116:Immunization, Passive; D007165:Immunosuppression Therapy / Q000379:methods; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis
D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens