Use of HBSAG Quantification To Guide HBIG Prophylaxis After Liver Transplantation

Abstract

Hepatitis B surface antigen (HBsAg) quantification has recently been introduced to guide treatment in chronic hepatitis B virus (HBV) patients. No information is currently available on use of HBsAg levels to guide HBV immune globulin (HBIG) administration after liver transplantation (LT). We performed a retrospective analysis of a prospectively collected database. Patients were included if: adults (≥18 years); recipients of a primary liver graft; HBsAg-positive and HBV DNA-negative at transplantation; hepatitis C and/or HIV-negative; not transplanted for fulminant hepatic failure; on nucleoside analogues. All patients were administered 30,000 IU HBIG, perioperatively, and hepatitis B surface antibody (HBsAb) was tested at day 7, 14, 28, and monthly thereafter. A further 30,000 HBIG were administered if HBsAb <100 mIU/mL and/or HBsAg >100 IU/mL on day 7. The primary endpoint was the efficacy of HBIG as a percentage of patients achieving HBsAg <100 IU/mL and HBsAb ≥100 mIU/mL at day 7. Secondary endpoints were performance of HBsAg levels in predicting HBsAg loss at day 7, HBV recurrence, graft, and patient survival at last follow-up. 41 LT recipients – transplanted between January 2011 and June 30, 2013 – were included (median age 54 years; male 78%). Hepatocellular carcinoma was present in 24 (58.5%) and hepatitis delta in 19 patients (46.4%); 7 (17.1%) patients did not achieve efficacy at day 7 and wereboosted with additional 30,000 HBIG. A pre-transplant HBsAg level ≥1,000 IU/mL was associated with 60-fold odds for failure at day 7 (p=0.0002). At a median follow-up of 14 months after LT, graft and patient survival were 100% and no case of HBV recurrence had been observed. Based on our results, we advocate the use of HBsAg titre to guide HBIG prophylaxis after LT.