Anti-HBs response to hepatitis B immunoglobulin prophylaxis in liver transplant recipients.
BACKGROUND
Hepatitis B virus (HBV) recurrence after a liver transplant (LT) is a global issue. Several strategies have been adopted to prevent this recurrence. Most strategies recommend a combination of hepatitis B immunoglobulin (HBIG) and or nucleos(t)ide analogue.


OBJECTIVE
The aim of the study is to determine the anti-HBs response to HBIG among Indian patients who had undetectable pre-transplant HBV DNA.


METHODS
Seven adult HBV-related LT recipients of Indian origin with low pre-transplant HBV titres who had a liver transplant between August 2009 and June 2012 were included in the study. The protocol followed for post-liver transplant HBIG dose was titrated to achieve an anti-HBs titre of at least 100 IU/L. All recipients were on entecavir. Anti-HBs titre, and HBsAg status was checked at regular intervals. A retrospective analysis of the anti-HBs response to a loading and maintenance dose of HBIG was done.


RESULTS
Seven adult HBV-related LT recipients on post-transplant prophylaxis with HBIG and nucleoside analogue (entecavir) fulfilled the criteria for the study. The median anti-HBs response to the anhepatic and loading dose of HBIG was high at 555 IU/L. In two, the response was less than 100 IU/L. The median dose of HBIG reduced at end of 1 month to 800 IU, and the median titre was 223 IU/L. For the next 11 months, the median requirement of HBIG was 3,000 and 4,000 IU, and the titre was low at 53.8 and 60.9 IU/L at end of 6 and 12 months, respectively.


CONCLUSIONS
The anti-HBs response to HBIG was variable, and titres even below 100 IU/L did not result in HBV recurrence when HBIG was given in combination with entecavir.
Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Perumbakkam, Chennai, 600 100, India, joyvargese@gmail.com.
Joy
J
Varghese
Mettu Srinivas
MS
Reddy
Thomas
T
Cherian
Srinivasan
S
Vijaya
Venkataraman
V
Jayanthi
Mohamed
M
Rela
D000998:Antiviral Agents / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006509:Hepatitis B / Q000517:prevention & control*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D007194:India; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012008:Recurrence; D012189:Retrospective Studies
D000998:Antiviral Agents; D007136:Immunoglobulins; C413685:entecavir; D006147:Guanine; C045213:hepatitis B hyperimmune globulin