HBIg Discontinuation with Maintenance Oral Anti-viral Therapy and HBV Vaccination in Liver Transplant Recipients

• DOI: 10.1007/s10620-009-0999-6
• Publication Date: 2009-10-01T21:59:35Z
• Authors: Nicholas K. Weber; Lisa M. Forman; James F. Trotter
• Keywords: Adult; Male; 0301 basic medicine; Hepatitis B virus; Time Factors; Immunization, Passive; Administration, Oral; Immunoglobulins; Middle Aged; Antiviral Agents; Liver Transplantation; 3. Good health; 03 medical and health sciences; Hepatitis B, Chronic; Treatment Outcome; DNA, Viral; Secondary Prevention; Humans; Female; Hepatitis B Vaccines; Aged; Follow-Up Studies; Retrospective Studies

Hepatitis B (HBV) is an uncommon indication for liver transplantation in the US accounting for approximately 5% of cases. Recurrence prophylaxis is typically long-term hepatitis B immune-globulin (HBIg) and an oral anti-HBV agent. Because of high HBIg costs and improving efficacy of new oral agents, there is increasing interest in HBIg discontinuation.To describe results of a protocol at our center including HBV vaccination and HBIg discontinuation.All patients received HBIg therapy and an oral anti-viral agent from the time of transplant. Patients transplanted for HBV with a stable post-operative clinical course underwent HBV vaccination and HBIg discontinuation. After HBIg discontinuation, patients were monitored for HBV recurrence for at least one year. Recurrence was defined as either viral (HBV-DNA 10(4) copies/ml on two consecutive occasions) or hepatitis (viral recurrence with elevated liver transaminases).Of 1182 recipients, 36 (3%) had HBV. Twenty-four were excluded from the protocol, and the remaining 12 patients underwent HBIg withdrawal. Median age at HBIg discontinuation was 56 (range, 36-70) years, median time from transplant to HBIg discontinuation was 62.8 (range, 27.5-128) months, and median time of follow-up after discontinuation was 27.4 (range, 13-69) months. Of the 12 patients vaccinated, no patients maintained HBSAb >or= 10 IU/l at last follow-up. There was no viral or hepatitis recurrence and no deaths or graft loss.HBIg discontinuation with maintenance oral anti-viral monotherapy is safe and effective for HBV liver transplant recipients. Vaccination is not effective in this population.