title: Hepatitis B immunoglobulin prophylaxis after liver transplantation: experience in a tertiary transplant centre.
abstract: BACKGROUND
  Prophylaxis with hepatitis B immunoglobulin (HBIG) and nucleoside analogs can prevent hepatitis B virus (HBV) recurrence after liver transplant (LT).
  
  
  OBJECTIVE
  To determine the efficacy and cost of maintaining immunoprophylaxis with HBIG and hyperimmune plasma (HIP) for 6 months after LT.
  
  
  METHODS
  The study included 22 HBV related LT recipients who were on entecavir and either HBIG or HIP for 6 months. Post transplant HBIG or HIP dose and cost incurred towards prophylaxis were noted. The cost of 200 IU of HBIG at the time of study was Rs 8250/- (US Dollars 135) and that of 2000 IU of HIP was Rs 8000/- (USD 130.7). The loading and maintenance costs at end of 6 months were compared between the two groups. Response to HBIG and HIP was assessed by checking for HBsAg reactivity, anti HBs titer response and HBV DNA viral load.
  
  
  METHODS
  Median and range, Kruskal Wallis (KW) sign rank Sum Test and Correlation Coefficient (r2) was used for analysis.
  
  
  RESULTS
  Thirteen recipients received HBIG and 9 recipients HIP. The anti HBs response to HIP was significantly high compared to HBIG (KW Sign rank Sum test P < 0.05); titers remained high until the study period. Between 8 and 30 days, the titer achieved by both HBIG and HIP was similar (KW Sign rank Sum test not significant). Despite low anti HBs titer of <100 IU/L, none of the recipients on HBIG had HBsAg reactivity while 3 on HIP had transient HBsAg positivity. The total cost with HBIG was 13.9 times the cost of HIP.
  
  
  CONCLUSIONS
  HIP immunoprophylaxis in combination with entecavir achieves a high anti HBs titer at a significant low cost during anhepatic and loading phase. HBV reactivation rates with HBIG and HIP is low despite low anti HBs titer.
authors.affiliation: Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Joy
authors.initials: J
authors.lastname: Varghese
authors.affiliation: Department of Transfusion Medicine, Global Hospitals & Health City, Chennai, India.
authors.forename: Deepti
authors.initials: D
authors.lastname: Sachan
authors.affiliation: Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Mettu S
authors.initials: MS
authors.lastname: Reddy
authors.affiliation: Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Tom
authors.initials: T
authors.lastname: Cherian
authors.affiliation: Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Jothimani
authors.affiliation: Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Kota
authors.initials: K
authors.lastname: Venugopal
authors.affiliation: Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Olithselvan
authors.initials: O
authors.lastname: Arikichenin
authors.affiliation: Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Rajasekar
authors.initials: R
authors.lastname: Perumalla
authors.affiliation: Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Gomathy
authors.initials: G
authors.lastname: Narasimhan
authors.affiliation: Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Vivekananthan
authors.initials: V
authors.lastname: Shanmugam
authors.affiliation: Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Vijaya
authors.affiliation: Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Venkataraman
authors.affiliation: Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
keywords: ESLD, end-stage liver disease; HBIG, hepatitis B immunoglobulin; HBV recurrence; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HIP, hyper-immune plasma; HIV, human immunodeficiency virus; Hepatitis B virus; KW, Kruskal Wallis; LT, liver transplantation; NA, nucleos(t)ide analogs; USD, US Dollars; anti HBs Ab, anti hepatitis B virus antibody; hepatitis B immunoglobulin; hyper-immune plasma; liver transplantation