Short-term high-dose followed by long-term low-dose hepatitis B immunoglobulin and lamivudine therapy prevented recurrent hepatitis B after liver transplantation.
Hepatitis B immunoglobulin (HBIg) and lamivudine combination has been accepted as the best way to control hepatitis B recurrence after liver transplantation. However, the optimal dose of HBIg and the target titer of hepatitis B surface antibody (HBsAb) remain unclear. We report our satisfactory experience with high-dose HBIg in the early period followed by low-dose HBIg with lamivudine. Subjects comprised five patients with fulminant hepatitis (FH) and 18 patients with liver cirrhosis (LC) who underwent liver transplantation. HBIg at a dosage of 200 IU/kg per day was administered for one week postoperatively. Thereafter, HBIg was administered only for HBsAb titer <100 IU/L. After six months, HBIg was withdrawn in FH and administered in LC only for HBsAb titer <10 IU/L. Lamivudine was administered to two FH and all LC cases. Although two patients with LC showed transient hepatitis B surface antigen (HBsAg) recurrence, all patients remained HBsAg-negative at the final follow-up date. This method allows reliable and cost-effective control of hepatitis B recurrence.
Takaki
Akinobu
A
Department of Gastroenterology, Transplant and Surgical Oncology, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Japan. akitaka@md.okayama-u.ac.jp
Yagi
Takahito
T
Iwasaki
Yoshiaki
Y
Sadamori
Hiroshi
H
Matsukawa
Hiroyoshi
H
Matsuda
Hiroaki
H
Shinoura
Susumu
S
Umeda
Yuuzou
Y
Miyake
Yasuhiro
Y
Terada
Ryou
R
Kobashi
Haruhiko
H
Sakaguchi
Kohsaku
K
Tanaka
Noriaki
N
Shiratori
Yasushi
Y
D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000276:immunology* / Q000517:prevention & control* / Q000601:surgery / Q000821:virology; D006511:Hepatitis B Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000276:immunology* / Q000627:therapeutic use*; D007167:Immunotherapy; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology; D055502:Secondary Prevention; D013997:Time Factors
D006511:Hepatitis B Antigens; D007136:Immunoglobulins; D019259:Lamivudine