title: Minimization of anti-hepatitis B surface antigen immunoglobulins for prophylaxis of hepatitis B viral recurrence in the first month after liver transplantation: the meaning of HBsAg quantitative level at the time of transplant.
abstract: BACKGROUND
  Hepatitis B virus recurrence after liver transplantation (LT) has practically disappeared with a prophylaxis combining anti-hepatitis B surface antigen Immunoglobulins (HBIg) and antiviral drugs. Recently, cost-saving requirements pushed us to move from a fixed schedule of 50,000 IU intravenous HBIg in the first month after LT to an "on demand" administration guided by close monitoring of HBV surface antigen (HBsAg) and anti-HBV surface Antigen antibody (HBsAb) with a serological target of HBsAg negative and HBsAb>300 mIU/mL. In this context, we investigated the meaning of HBsAg quantitative determination at LT in predicting the need of HBIg in the first month after LT.
  
  
  METHODS
  From February 2012 to July 2013, we performed 35 LTs in HBsAg-positive patients, 18 of whom had hepatitis Delta virus coinfection (Delta-positive). Anti-HBV prophylaxis was based on nucleos(t)ide analogues from day 1 post-LT and intravenous HBIg (10,000 IU intraoperatively and, in the following days, 5,000 IU and 2,500 IU pulses to reach and maintain the serological target).
  
  
  RESULTS
  The HBsAg quantitative level at LT was significantly higher in Delta-positive recipients. Complete negativization of HBsAg and HBsAb serum level>300 mIU/mL was achieved on day 3 in Delta-positive and on day 2 in Delta-negative. A positive linear correlation between HBsAg quantitative level at LT and HBIg administered in the first month after LT was observed (RHO=.788), with a total of 32,500 IU HBIg used in HDV-positive and 22,000 IU in HDV-negative recipients (P=.0016). Compared to the old schedule, we saved a median of 14,750 IU in HDV-positive and 28,000 IU in Delta-negative. No HBV recurrence was observed in a median follow-up of 10.5 months.
  
  
  CONCLUSIONS
  Delta-positive patients need higher doses of HBIg to reach the serological target after LT because they have greater HBsAg quantitative levels at LT. In future studies, pre-LT HBsAg quantitative determination will be helpful to predict the actual need of HBIg early after LT.
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy. Electronic address: ftandoi@unito.it.
authors.forename: F
authors.initials: F
authors.lastname: Tandoi
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Nada
authors.affiliation: Microbiology and Virology Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pittaluga
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fop
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lupo
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Romagnoli
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045213:hepatitis B hyperimmune globulin