title: Hyperimmune anti-HBs plasma as alternative to commercial immunoglobulins for prevention of HBV recurrence after liver transplantation.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Geneva, Switzerland. f.bihl@mac.com
authors.forename: Florian
authors.initials: F
authors.lastname: Bihl
authors.forename: Stefan
authors.initials: S
authors.lastname: Russmann
authors.forename: Vanina
authors.initials: V
authors.lastname: Gurtner
authors.forename: Loriana
authors.initials: L
authors.lastname: Di Giammarino
authors.forename: Loredana
authors.initials: L
authors.lastname: Pizzi-Bosman
authors.forename: Martine
authors.initials: M
authors.lastname: Michel
authors.forename: Andreas
authors.initials: A
authors.lastname: Cerny
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Damiano
authors.initials: D
authors.lastname: Castelli
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin