Hepatitis B Immunoglobulin Prophylaxis after Liver Transplantation: Experience in a Tertiary Transplant Centre

Abstract

Background: Prophylaxis with hepatitis B immunoglobulin (HBIG) and nucleoside analogs can prevent hepatitis B virus (HBV) recurrence after liver transplant (LT). Aim: To determine the efficacy and cost of maintaining immunoprophylaxis with HBIG and hyperimmune plasma (HIP) for 6 months after LT. Material & methods: The study included 22 HBV related LT recipients who were on entecavir and either HBIG or HIP for 6 months. Post transplant HBIG or HIP dose and cost incurred towards prophylaxis were noted. The cost of 200 IU of HBIG at the time of study was Rs 8250/-(US Dollars 135) and that of 2000 IU of HIP was Rs 8000/-(USD 130.7). The loading and maintenance costs at end of 6 months were compared between the two groups. Response to HBIG and HIP was assessed by checking for HBsAg reactivity, anti HBs titer response and HBV DNA viral load. Statistical analysis: Median and range, Kruskal Wallis (KW) sign rank Sum Test and Correlation Coefficient (r2) was used for analysis. Results: Thirteen recipients received HBIG and 9 recipients HIP. The anti HBs response to HIP was significantly high compared to HBIG (KW Sign rank Sum test P < 0.05); titers remained high until the study period. Between 8 and 30 days, the titer achieved by both HBIG and HIP was similar (KW Sign rank Sum test not significant). Despite low anti HBs titer of <100 IU/L, none of the recipients on HBIG had HBsAg reactivity while 3 on HIP had transient HBsAg positivity. The total cost with HBIG was 13.9 times the cost of HIP. Conclusion: HIP immunoprophylaxis in combination with entecavir achieves a high anti HBs titer at a significant low cost during anhepatic and loading phase. HBV reactivation rates with HBIG and HIP is low despite low anti HBs titer. ( J CLIN EXP HEPATOL 2014;4:209-213)

Current Scenario of Hepatitis B and Its Treatment in India

“… 145 Another study of LT cases compared the cost of 6 months post-transplant HBIg with that of hyperimmune plasma (containing high antiHBs titre), along with ETV therapy in both groups; the latter was found to be 14-times less costly and to yield low and transient HBsAg reactivity. 146 The benefit of TDF has also been shown in cases of acute-on-chronic liver failure due to HBV in reducing mortality for up to 3 months. 147 …”

Therapeutic Plasma Exchange Using Convalescent Plasma Replacement Therapy in Severe COVID-19 Infections: A Potential Therapeutic Option

“…Plasma rich with anti-hepatitis B virus antibodies, known as hyper immune plasma, was given in a dose of 2,000 IU/L to maintain adequate anti-hepatitis B virus antibody levels to prevent hepatitis B virus recurrence. 14 In a press release from February 2020 (unpublished data), China reported that it used plasma of convalescent individuals in 245 patients with COVID-19 and reported good survival benefits. Zhang B et al 15 published their first case series on effectiveness of convalescent plasma in four patients with severe COVID-19, who were on ventilator support with more than one organ failure and who did not show clinical or biochemical improvement after standard recommended therapy.…”

Prevención de recurrencia de infección por hepatitis B en receptores de trasplante hepático utilizando dosis bajas de inmunoglobulina antihepatitis B y análogo de nucleósido

“…HBIG combinado con un antiviral de alta barrera genética (tenofovir o entecavir) (13,16,17), e incluso esquemas libres de HBIG (18). Choudhary y colaboradores reportaron un estudio que utilizó HIBG por 12 meses seguido de tenofovir o entecavir (19), que mostró una tasa de recaída del 4,3% a una mediana de seguimiento de 43 meses .…”