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Hepatitis B Immune Globulin Withdrawal in HBsAg Positive Liver Transplant Patients.

A. Nolan,1 C. Onwudiwe,1 A. Rangnekar,2 R. Satoskar,2 T. Fishbein.2

1Department of Pharmacy, Medstar Georgetown University Hospital, Washington, DC
2Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC.

Meeting: 2016 American Transplant Congress

Abstract number: D286

Keywords: Hepatitis B, Liver transplantation

Session Information

Date: Tuesday, June 14, 2016

Session Name: Poster Session D: Viral Hepatitis

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Related Abstracts
  • Limited Hepatitis B Immune Globulin Following Liver Transplant for Hepatitis B.
  • Effective Long-Term Prophylaxis against De Novo Hepatitis B With Hepatitis B Vaccination in Pediatric Recipients of HbcAb-Positive Liver Grafts

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).

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To cite this abstract in AMA style:

Nolan A, Onwudiwe C, Rangnekar A, Satoskar R, Fishbein T. Hepatitis B Immune Globulin Withdrawal in HBsAg Positive Liver Transplant Patients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/hepatitis-b-immune-globulin-withdrawal-in-hbsag-positive-liver-transplant-patients/. Accessed March 8, 2021.

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