Hepatitis B immune globulin for life versus limited use: I favor limited duration of therapy

  title={Hepatitis B immune globulin for life versus limited use: I favor limited duration of therapy},
  author={John R. Lake},
  journal={Liver Transplantation},
  • J. Lake
  • Published 1 October 2002
  • Medicine
  • Liver Transplantation
The initial enthusiasm for performing orthotopic liver transplantation (OLT) on patients with chronic hepatitis B virus (HBV) infectionwas tempered in the early 1990s by a high rate of recurrent infection, with the subsequent development of severe recurrent hepatitis frequently leading to loss of the allograft.1 In the absence of effective therapy, recurrent infection, defined as the appearance after OLT of detectable hepatitis B surface antigen (HBsAg) in serum, occurred in 70% to 90%2 of… 
1 Citations
Management of chronic hepatitis B in the liver transplant setting
Five-year resistance surveillance programs are currently ongoing to monitor the emergence of ADV-resistant mutants in the long-term, and newer nucleoside analogs may provide a rescue therapy for LAM-resistant strains to avoid potential aggressive courses of HBV graft reinfection in liver transplant recipients.


A multicenter study of lamivudine treatment in 33 patients with hepatitis B after liver transplantation
  • R. Fontana, H. Hann, +7 authors N. Brown
  • Medicine
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 2001
Study results show that lamivudine is safe and effective in liver transplant recipients with recurrent hepatitis B, however, the high rate of virological breakthrough with prolonged therapy indicates the need for further studies of combination antiviral therapy in this patient population.
New Era of Liver Transplantation for Hepatitis B: A 17-Year Single-Center Experience
When compared with a nontreated cohort, OLT recipients receiving combination viral prophylaxis with HBIg and lamivudine showed markedly reduced HBV recurrence rates and significantly improved 1- and 3-year recurrence-free survival rates.
Liver transplantation in European patients with the hepatitis B surface antigen.
In this retrospective study of HBsAg-positive patients, liver transplantation had better results in those who had fulminant hepatitis or delta virus superinfection and reduced mortality.
Randomized trial of lamivudine versus hepatitis B immunoglobulin for long-term prophylaxis of hepatitis B recurrence after liver transplantation.
Substitution of HBIg with lamivudine is effective for prevention of HBV recurrence in low-risk liver transplant recipients and offers a convenient and cost-effective alternative for long-term HBV prophylaxis.
Hepatitis B virus reinfection after orthotopic liver transplantation. Serological and clinical implications.
The implications of hepatitis B virus (HBV) reinfection after liver transplantation were studied in 29 patients followed for 1.7-15 years, finding co-existing HDV infection appeared to confer some medium-term protection from graft loss.
Successful treatment with adefovir dipivoxil in a patient with fibrosing cholestatic hepatitis and lamivudine resistant hepatitis B virus
This case report suggests firstly, that advanced FCH can be reversed and secondly, that addition of adefovir dipivoxil to lamivudine and HBIg may be an effective antiviral strategy.
Increasing applicability of liver transplantation for patients with hepatitis B–related liver disease
Based on the experience, hepatitis B patients, including those with active viral replication, should not be excluded from liver transplantation, and excellent long‐term results can be achieved in hepatitis B Patients after liver transplants with modern strategies, and survival rates are similar to other indications.
Prevention of hepatitis B virus recurrence after liver transplantation in cirrhotic patients treated with lamivudine and passive immunoprophylaxis.
Over the medium-term, combined prophylaxis with lamivudine and HBIG significantly decreases the risk of hepatitis B recurrence after liver transplantation.
Prophylaxis in liver transplant recipients using a fixed dosing schedule of hepatitis B immunoglobulin
A fixed monthly dose of HBIg reduces the recurrence of HBs antigenemia, even in patients with indices of active viral replication pretransplantation, and the presence of residual virus in the majority of patients administered H BIg suggests that long‐term HBIG administration may be necessary.
A concise update on the status of liver transplantation for hepatitis B virus: The challenges in 2002
  • H. Vargas, F. Dodson, J. Rakela
  • Medicine
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 2002
Challenges remain for the next millennium, including the determination of cost‐effective dosing strategies, treatment of HBV infection in liver transplant recipients, and ramifications of the use of new antiviral agents, specifically, the appearance of resistant strains.