Hyperimmune anti-HBs plasma as alternative to commercial immunoglobulins for prevention of HBV recurrence after liver transplantation.
BACKGROUND
Hepatitis B immune globulins (HBIG) in combination with nucleos(t)ide analogues (NA) are effectively used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, associated treatment costs for HBIG are exceedingly high.


METHODS
Fresh frozen plasma obtained from blood donors with high anti-HBs levels (hyperimmune plasma, HIP) containing at least 4,500 IU anti-HBs was used as alternative treatment for HBV recurrence prophylaxis post-LT.


RESULTS
Twenty-one HBV-related LT recipients received HIP starting at transplantation, followed by long-term combination treatment with NA. Mean follow-up time was 4.5 years (range 0.5-12.6) and each patient received on average 8.2 HIP per year (range 5.8-11.4). Anti-HBs terminal elimination kinetic after HIP administration was 20.6 days (range 13.8-30.9), which is comparable to values reported for commercial HBIG products. All 21 patients remained free of HBV recurrence during follow-up and no transfusion-transmitted infection or other serious complication was observed. Seven patients developed reversible mild transfusion reactions. The cost for one HIP unit was US$140; average yearly HBIG treatment cost was US$1,148 per patient, as compared to US$25,000-100,000 for treatment with commercial HBIG.


CONCLUSIONS
The results of this study suggest that the use of HIP may be a useful and economical approach for the prevention of HBV recurrence post-LT if used in combination with NA. Additional prospective controlled studies in larger populations are needed to confirm these results.
Bihl
Florian
F
Department of Gastroenterology and Hepatology, University Hospital of Geneva, Switzerland. f.bihl@mac.com
Russmann
Stefan
S
Gurtner
Vanina
V
Di Giammarino
Loriana
L
Pizzi-Bosman
Loredana
L
Michel
Martine
M
Cerny
Andreas
A
Hadengue
Antoine
A
Majno
Pietro
P
Giostra
Emiliano
E
Castelli
Damiano
D
Mentha
Gilles
G
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000191:economics / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007136:Immunoglobulins / Q000191:economics / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010949:Plasma; D055502:Secondary Prevention; D016896:Treatment Outcome
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin