Optimal Level of Hepatitis B Surface Antibody for
Prevention of Recurrent Hepatitis B Following Liver
Transplantation: A Retrospective Study
Komolmit P, MD, PhD¹, Srisoonthorn N, RN¹, Thanapirom K, MD¹, Poovorawan K, MD², Treeprasertsuk S, MD, PhD¹
Affiliation : ¹ Center of Excellence in Liver Diseases, King Chulalongkorn Memorial Hospital and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ² Gastroenterology Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Background: The combinative regimens using oral nucleos(t)ide analogs (NA) plus either regular or on-demand low dose hepatitis
B immunoglobulin (HBIG) have shown significant decrease in recurrence of post-liver transplantation (LT) hepatitis B, leading to
considerable cost saving. Most of the protocols aimed to maintain hepatitis B surface antibody (HBsAb) levels above 100 IU/mL.
Objective: To demonstrate that the maintenance threshold for HBsAb level could be lowered to 50 IU/mL for hepatitis B virus (HBV) prophylaxis during post-LT.
Materials and Methods: The authors conducted a retrospective study of 45 patients that undergone LT for HBV-related diseases between 2003 and 2015. All patients had been followed-up and placed on a post-LT anti-HBV regimen of on-demand low-dose HBIG plus NAs. A fixed dose of 800 U HBIG was given as required to maintain HBsAb levels above 50 IU/mL. HBV recurrence was defined as persistent reappearance of HBsAg.
Results: The mean follow-up was 57.8±38.3 months (range 6 months to 12 years), and no patient experienced HBV recurrence during that period. However, two patients experienced a few episodes of non-sustained HBsAg seropositivity without active disease, which indicated an actuarial risk of recurrence of 4.4%. The mean level of HBsAb in each stratified period was well maintained above 50 IU/mL. The estimated cost of HBIG was approximately 50% of the cost for the regular low-dose regimen.
Conclusion: The present regimen yielded good result and significant cost reduction. The authors propose the maintenance HBsAb level could be reduced to 50 IU/mL without compromising the clinical outcome.
Keywords : Liver transplantation, Hepatitis B, Hepatitis B immunoglobulin, HBsAb level, Nucleoside analog
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