Introduction: Liver transplantation for chronic hepatitis B virus (HBV) is associated with a high recurrence rate of HBV post-transplant without the use of prophylaxis. The use of hepatitis B immune globulin (HBIG) and the addition of lamivudine decreased rates of recurrence. Two new potent antiviral agents, entecavir and tenofovir, are being utilized in hepatitis B treatment, although minimal data exists for their long-term use to prevent hepatitis B post-transplant in conjunction with low-dose, short-term HBIG therapy.

Objective: The objective of this study is to review the effectiveness of an HBIG- minimizing protocol to prevent post-transplant HBV recurrence.

Methods: To minimize the use of expensive HBIG and to improve patient compliance, our institution's protocol was modified for post-transplant HBV prophylaxis. Low risk patients, defined as those with less than 10⁵ copies/ml hepatitis B DNA and HBeAg at the time of transplant, receive 1 year of HBIG 1560 units intramuscular injection monthly after initial induction with intravenous HBIG, plus lifelong entecavir or tenofovir. During this time period, patients who had already completed 1 year of HBIG could discontinue therapy. Patients were monitored every 3 months for presence of HBV DNA and HBsAg.

Results: Seventeen low-risk HBsAg positive patients were transplanted between 2012 and 2014. Patients received HBIG for a median of 12 months post transplant (range 10-24 months). Three patients received entecavir and fourteen patients received tenofovir. At a mean of 844 days of follow up post-transplant (range: 361-1405 days), all patients remain HBV DNA undetectable and hepatitis B surface antigen negative. One patient died of recurrent cholangiocarcinoma more than 1 year post-transplant.

Conclusion: The use of entecavir or tenofovir in conjunction with one year of intramuscular low-dose HBIG is safe and effective for the prevention for hepatitis B recurrence post-liver transplant and provides significant cost savings for health care institutions.

CITATION INFORMATION: Nolan A, Onwudiwe C, Rangnekar A, Satoskar R, Fishbein T. Hepatitis B Immune Globulin Withdrawal in HBsAg Positive Liver Transplant Patients. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress