Intramuscular hepatitis B immunoglobulin (HBIG) and nucleosides for prevention of recurrent hepatitis B following liver transplantation: comparison with other HBIG regimens.
High titer hepatitis B immunoglobulin (HBIG) has significantly reduced the recurrence of hepatitis B virus (HBV) infection after liver transplantation. We compared our experience with intramuscular (IM) HBIG prophylaxis to our earlier outcomes with intravenous (IV) HBIG and other regimens.


METHODS
One hundred and twenty-three patients with acute or chronic hepatitis B underwent liver transplant at the Baylor Regional Transplant Center between July 1985 and July of 2005. Of these, 63 (43%) received long-term low-dose IM (n = 17) or high-dose IV (n = 46) HBIG. All patients in IM group also received a nucleoside before and after transplant. These patients were compared with those transplanted earlier who received either no prophylaxis (n = 16) or HBIG on day zero and one only (n = 44).


RESULTS
HBV recurrence was significantly lower in patients who received long-term HBIG [9/38 (23.7%) for IV and 1/17 (5.9%) for IM] compared with patients who received no treatment (8/11; 72.7%) or only two doses of HBIG (32/40; 80.0%). Two-yr actuarial survivals were 89%, 88%, 54%, and 64%, respectively. Patients on long-term HBIG by either parenteral route survived as well as patients transplanted for other indications. Post-transplant recurrence of hepatitis B in the long-term HBIG groups was usually controlled by intensifying antiviral therapy.


CONCLUSIONS
Long-term low-dose IM and high-dose IV HBIG are equally efficacious with similar survival and early hepatitis recurrence rates. Graft loss is usually avoidable when recurrence is discovered early and aggressively treated. The IM route is preferable to IV administration due to its ease of administration and lower cost.
Anderson
Robert D
RD
Department of Medicine, Baylor Uinversity Medical Center and the Baylor Regional Transplant Institute, Dallas, TX, USA.
Chinnakotla
Srinath
S
Guo
Linsheng
L
Perrillo
Robert P
RP
Klintmalm
Göran B
GB
Davis
Gary L
GL
D000208:Acute Disease; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000235:genetics; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000517:prevention & control* / Q000821:virology; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous; D007273:Injections, Intramuscular; D017093:Liver Failure / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000627:therapeutic use*; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome
D000998:Antiviral Agents; D004279:DNA, Viral; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D009705:Nucleosides; C045213:hepatitis B hyperimmune globulin