Optimal level of hepatitis B surface antibody for prevention of recurrent hepatitis B following liver transplantation: A retrospective study

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND 2019. 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.