Abstract
Background: Hepatitis B surface antigen (HBsAg) quantification has recently been introduced to guide treatment in chronic HBV patients. Low HBV DNA (<2000 IU/mL) and HBsAg (<1000 IU/mL) levels can predict inactive carrier status and HBsAg loss in non-transplant populations. No information is currently available on use of HBsAg levels to guide HBV immune globulin (HBIG) administration after liver transplantation (LT). Materials and methods: Retrospective analysis of a prospectively collected database. Patients were included if: adults (≥18 years); recipients of a primary liver graft; HBsAg+ and HBV DNA- at transplantation; hepatitis C and/or HIV-; not transplanted for fulminant hepatic failure; on nucleoside analogs. All patients were administered 30,000 IU HBIG peri-operatively, and HBsAb was tested at day 7, 14, 28, and monthly thereafter. Further 30,000 HBIG were administered if HBsAb <100 mIU/mL on day 7 and/or HBsAg >100 IU/mL. Primary endpoint was efficacy of HBIG as percent of patients achieving HBsAg <100 IU/mL and HBsAb ≥100 mIU/mL at Day 7. Secondary endpoints were HBV recurrence, graft and patient survival at last follow-up. Results: 41 LT recipients transplanted between January 2011 and June 30, 2013 were included (mean age 53.6±7.8 years; males 78%). Hepatocellular carcinoma was present in 24 (58.5%) and hepatitis delta (HDV) infection in 19 (46.4%). HBsAg decreased from a mean of 1,070.8 (±2,654.8) IU/mL pre-transplantation to a mean of 304.1 (±845.4) at day 7 (p<0.0001). Seven (17.1%) patients did not achieve efficacy at day 7 and were boosted with additional 30,000 HBIG. A pre-transplant HBsAg level ≥1,000 IU/mL was the only predictor of efficacy of HBIG at day 7 post-LT (p =0.0002). At a mean of 16.8 (±6.7) months after LT, graft and patient survival are 100% and no case of HBV recurrence has been observed. Conclusions: A HBsAg titer ≥1000 IU/mL may be used to predict HBsAg loss in LT recipients undergoing HBIG prophylaxis. DISCLOSURES:De Simone, P.: Speaker's Bureau, Biotest Italy, Grifols.
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