TY - JOUR
T1 - Improved outcome of orthotopic liver transplantation for chronic hepatitis B cirrhosis with aggressive passive immunization
AU - Mcgory, Robert W.
AU - Ishitani, Michael B.
AU - Oliveira, Walter M.
AU - Stevenson, William C.
AU - Mccullough, Christopher S.
AU - Dickson, Rolland C.
AU - Caldwell, Stephen H.
AU - Pruett, Timothy L.
PY - 1996/5/15
Y1 - 1996/5/15
N2 - Passive immunization with hepatitis B surface antibody (anti-HBs) is important to prevent hepatitis B virus (HBV) recurrence after orthotopic liver transplantation for chronic HBV cirrhosis. Hepatitis B immune globulin (HBIG) dosing regimens have been poorly defined, utilize numerous routes of administration, and result in a high rate of HBV relapse and mortality. Twenty-five of 27 (93%) patients transplanted (four retransplants) for chronic HBV cirrhosis show no evidence of recurrent HBV (range, 2-55 months). Anti-HBs titers necessary to minimize the risk of hepatitis B surface antigen detectability were >500 IU/L for days 0 to 7, >250 IU/L for days 8 to 90, and >100 IU/L thereafter. Pretransplant HBV E antigen (HBeAg)-positive patients required more HBIG to achieve these goals than HBeAg-negative individuals. The elimination of anti-HBs changed continually for the initial 3 posttransplant months. The anti-HBs half-life increased from 0.7 days to 14.1 days. Anti-HBs elimination was significantly different in HBeAg+ and HBeAg- patients for the first week, but was subsequently indistinguishable after week 1. After 3 months, the half-life was statistically less for HBeAg+ patients, but the difference did not influence the clinical treatment regimens. Quantitative hepatitis B DNA levels did not predict the amount of HBIG required. HBV recurrence after orthotopic liver transplantation can be reduced by aggressive passive immunization. Pharmacokinetic analysis of anti- HBs elimination can improve immunoglobulin therapy and prevent recurrence of clinical hepatitis.
AB - Passive immunization with hepatitis B surface antibody (anti-HBs) is important to prevent hepatitis B virus (HBV) recurrence after orthotopic liver transplantation for chronic HBV cirrhosis. Hepatitis B immune globulin (HBIG) dosing regimens have been poorly defined, utilize numerous routes of administration, and result in a high rate of HBV relapse and mortality. Twenty-five of 27 (93%) patients transplanted (four retransplants) for chronic HBV cirrhosis show no evidence of recurrent HBV (range, 2-55 months). Anti-HBs titers necessary to minimize the risk of hepatitis B surface antigen detectability were >500 IU/L for days 0 to 7, >250 IU/L for days 8 to 90, and >100 IU/L thereafter. Pretransplant HBV E antigen (HBeAg)-positive patients required more HBIG to achieve these goals than HBeAg-negative individuals. The elimination of anti-HBs changed continually for the initial 3 posttransplant months. The anti-HBs half-life increased from 0.7 days to 14.1 days. Anti-HBs elimination was significantly different in HBeAg+ and HBeAg- patients for the first week, but was subsequently indistinguishable after week 1. After 3 months, the half-life was statistically less for HBeAg+ patients, but the difference did not influence the clinical treatment regimens. Quantitative hepatitis B DNA levels did not predict the amount of HBIG required. HBV recurrence after orthotopic liver transplantation can be reduced by aggressive passive immunization. Pharmacokinetic analysis of anti- HBs elimination can improve immunoglobulin therapy and prevent recurrence of clinical hepatitis.
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U2 - 10.1097/00007890-199605150-00013
DO - 10.1097/00007890-199605150-00013
M3 - Article
C2 - 8629297
AN - SCOPUS:0029879163
SN - 0041-1337
VL - 61
SP - 1358
EP - 1364
JO - Transplantation
JF - Transplantation
IS - 9
ER -