title: HBsAg level at time of liver transplantation determines HBsAg decrease and anti-HBs increase and affects HBV DNA decrease during early immunoglobulin administration.
abstract: OBJECTIVE
  Administration of hepatitis B immunoglobulin (HBIG) initially after liver transplantation of hepatitis B patients is considered important to prevent reinfection reliably. However, dosing schedules differ considerably between centers. We measured HBsAg, anti-HBs and HBV DNA kinetics to create a rational basis for dosing schemes.
  
  
  METHODS
  Thirteen patients (group A) received 10,000 IU HBIG in the anhepatic phase followed by 10,000 IU daily until HBsAg became negative, whereas five patients (group B) received 20,000 IU followed by 5000 IU every 30 min.
  
  
  RESULTS
  HBsAg levels at time of transplantation ranged from 0.12 to 12,990 IU/ml. Correlations between initial HBsAg and HBIG required to decrease HBsAg below 1 IU/ml were high in groups A and B (r=0.97, p<0.001; r=1.00, p<0.001), as were correlations between initial HBsAg and HBIG required to raise anti-HBs above 1000 IU/l (r=0.94, p<0.001; r=1.00, p<0.001). In 11 HBV DNA-positive patients, DNA levels became negative in seven, and dropped by 2.5 log10 (mean) in the other four patients during immunoglobulin administration.
  
  
  CONCLUSIONS
  In conclusion, required HBIG doses to decrease HBsAg and raise anti-HBs are determined by HBsAg levels at time of transplantation, not by HBV DNA levels. Shortened HBIG dosing intervals accelerate HBsAg decrease and anti-HBs increase. HBV DNA decreases rapidly during HBIG administration in most patients.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany. Rosenau.Jens@mh-hannover.de
authors.forename: Jens
authors.initials: J
authors.lastname: Rosenau
authors.forename: Therese
authors.initials: T
authors.lastname: Kreutz
authors.forename: Matthias
authors.initials: M
authors.lastname: Kujawa
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Bahr
authors.forename: Kinan
authors.initials: K
authors.lastname: Rifai
authors.forename: Nazanin
authors.initials: N
authors.lastname: Hooman
authors.forename: Andrea
authors.initials: A
authors.lastname: Finger
authors.forename: Gerd
authors.initials: G
authors.lastname: Michel
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Kuse
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Hans L
authors.initials: HL
authors.lastname: Tillmann
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000627:therapeutic use; D007700:Kinetics; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D055502:Secondary Prevention
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin