Costs and efficacy of "on demand" low-dose immunoprophylaxis in HBV transplanted patients: experience in the Romanian program of liver transplantation.
BACKGROUND
HBV in liver transplant (LT) patients is associated with good outcomes and the challenges are primarily focused around optimizing prophylactic regimens with hepatitis B immune globulin (HBIG) and minimizing related costs.


OBJECTIVE
To identify recurrence rates in patients transplanted for HBV or HBV+HDV infection in whom a combined "on demand" low-dose HBIG was used, maintaining low anti-HBs titres (not below 50 IU/L).


METHODS
Medical records of 42 patients transplanted for HBV or HBV+HDV induced cirrhosis between April 2000 and September 2007 at Fundeni Clinical Institute were analyzed. Patients received immunoprophylaxis with lamivudine and HBIG (10,000 IU within anhepatic phase and daily within the first postoperative week, followed by 2,500 IU on demand). HBV recurrence rates and survival during follow-up were evaluated using the Kaplan Meier method.


RESULTS
HBV recurrence rate was 4.8% after a median of 1.8 years. Three year patient survival rate was 70%. None of the patients died due to liver failure related to HBV recurrence. Using our "on demand" low-dose administration of HBIG, the total mean cost for HBIG and lamivudine for patient per month of survival was 598.3 Eur. The projected monthly cost for the "ideal" schedule/patient was 2,017 Eur.


CONCLUSIONS
Individualization of immunoprophylaxis after LT for HBV related disease according to the lowest protective anti-HBs titers in combination with lamivudine is probably the best approach for non-replicative pre-LT patients in terms of costs and efficacy.
Iacob
Speranta
S
Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Sos. Fundeni nr. 258, Bucharest, Romania. speranta.iacob@icfundeni.ro
Hrehoret
Doina
D
Matei
Emil
E
Dorobantu
Bogdan
B
Gangone
Eliza
E
Gheorghe
Liana
L
Popescu
Irinel
I
D000328:Adult; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000187:drug effects; D003699:Hepatitis D / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000191:economics*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000191:economics; D007167:Immunotherapy / Q000191:economics*; D019259:Lamivudine / Q000008:administration & dosage / Q000191:economics; D017093:Liver Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012008:Recurrence; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000191:economics; D012383:Romania / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome
D006514:Hepatitis B Surface Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine