Background: Hepatitis B virus (HBV)-related liver disease is the major indication of liver transplantation in Asian countries. Combination of anti-hepatitis B immunoglobulin (HBIg) and anti-viral agents can effectively prevent HBV recurrence. However, HBIg is expensive. How long and what dose of HBIg should be used for prophylaxis of HBV recurrence is still controversial.

Materials and methods: 313 HBV patients who had liver transplantation from 2005 to 2015 and survived for more than 3 months were included in this study. All patients had anti-HBV nucleotide / nucleoside from postoperative day 1. Before 2008 (stage I), HBIg regimen was 10000IU intravenously during an-hepatic phase followed by 2000IU/day for a week. After 2008 (stage II), the peri-operative dosage of HBIg was the same as in stage I. Additionally, the immunoglobulin titers were measured at postoperative month (POM) 1 and 3. If immunoglobulin titer was less than 200IU/ml at POM 1 or less than 30IU/ml at POM 3, HBIg (800IU) were boosted for additional 6 months. Hepatitis B surface antigen (HBs Ag) was measured every 3 months. HBV recurrence was defined as positive for HBs Ag in the serum.

Results: Eighty-one patients who received short-term/low dose HBIg and long-term anti-viral agents after transplantation were included in stage 1. Twenty patients (24.7%) had HBV recurrence. The other 232 patients were included in stage II. 137 patients were not boosted with HBIg. Ninety-five patients were boosted with HBIg due to rapid decline of immunoglobulin titers. Totally, 28 patients (12.1%) in stage II had HBV recurrence which was lower than that in stage I (p = 0.011). For further analysis, 18 patients (18.9%) in boosting group and 10 (7.3%) patients in non-boosting group had HBV recurrence. The patients needing HBIg boosts had a higher HBV recurrent rate than the patients without needing HBIg boosts (p = 0.013). The data implied that the patients with rapid decline of anti-HBV immunoglobulin had high risk for HBV recurrence.

Conclusion: HBV patients need HBIg and anti-viral agents for prophylaxis of HBV recurrence after transplantation. The patients can divided into high and low risky groups according the decline of immunoglobulin titers and received different dosage of HBIg for prophylaxis of HBV recurrence.

CITATION INFORMATION: Lee W.-C, Wang Y.-C, Cheng C.-H, Wu T.-H, Lee C.-F, Wu T.-J, Chou H.-S, Chan K.-M. A Low-Dose Anti-Hepatitis B Immunoglobulin Regimen for Prophylaxis of Hepatitis B Recurrence. Am J Transplant. 2017;17 (suppl 3).

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