title: Subcutaneous administration of hepatitis B immune globulin in combination with lamivudine following orthotopic liver transplantation: effective prophylaxis against recurrence.
abstract: Prophylaxis against recurrent hepatitis B virus (HBV) infection with hepatitis B immune globulin (HBIG), in combination with antiviral agents such as lamivudine, has allowed transplantation for this condition to become feasible and accepted. Current protocols allow for HBIG administration either intravenously or intramuscularly. To date, there has been no reported experience with the subcutaneous route of post-transplant HBIG delivery. We report our experience of a 60-yr-old man for whom liver transplantation was performed for chronic HBV. HBIG was administered intramuscularly during the anhepatic phase of surgery. The finding of a portal vein thrombosis requiring repeated thrombectomy necessitated chronic anticoagulation. Post-operatively, HBIG was administered subcutaneously, in four separate injections, for a daily dose of 2170 IU along with continued lamivudine dosing. Hepatitis B surface antibody (anti-HBs) titres reached a serum concentration of >500 IU/L by seven d post-transplant and approximately 1000 IU/L by nine d post-transplant. Five months post-transplant, with continued combination of subcutaneous HBIG and lamivudine, there has been no recurrent HBV infection and anti-HBs titres have been at target levels. Our experience suggests that subcutaneous delivery of HBIG may be a feasible consideration when intramuscular/intravenous dosing is not possible.
authors.affiliation: Department of Surgery, University of British Columbia, British Columbia Transplant Society, Vancouver General Hospital, BC, Canada.
authors.forename: James J
authors.initials: JJ
authors.lastname: Powell
authors.forename: Wichian
authors.initials: W
authors.lastname: Apiratpracha
authors.forename: Nilufar
authors.initials: N
authors.lastname: Partovi
authors.forename: Siegfried R
authors.initials: SR
authors.lastname: Erb
authors.forename: Charles H
authors.initials: CH
authors.lastname: Scudamore
authors.forename: Urs P
authors.initials: UP
authors.lastname: Steinbrecher
authors.forename: Andrezj K
authors.initials: AK
authors.lastname: Buczkowski
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Chung
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use*; D019259:Lamivudine / Q000627:therapeutic use*; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin