IMPROVED OUTCOME OF ORTHOTOPIC LIVER-TRANSPLANTATION FOR CHRONIC HEPATITIS-B CIRRHOSIS WITH AGGRESSIVE PASSIVE-IMMUNIZATION

Passive immunization with hepatitis B surface antibody (anti-HBs) is i mportant to prevent hepatitis B virus (HBV) recurrence after orthotopi c liver transplantation for chronic HBV cirrhosis. Hepatitis B immune globulin (HBIG) dosing regimens have been poorly defined, utilize nume rous routes of administration, and result in a high rate of HBV relaps e and mortality. Twenty-five of 27 (93%) patients transplanted (four r etransplants) for chronic HBV cirrhosis show no evidence of recurrent HBV (range, 2-55 months), Anti-HBs titers necessary to minimize the ri sk of hepatitis B surface antigen detectability were >500 IU/L for day s 0 to 7, >250 IU/L for days 8 to 90, and >100 IU/L thereafter, Pretra nsplant HBV E antigen (HBeAg)-positive patients required more HBIG to achieve these goals than HBeAg-negative individuals. The elimination o f anti-HBs changed continually for the initial 3 posttransplant months . The anti-HBs half-life increased from 0.7 days to 14.1 days. Anti-HB s elimination was significantly different in HBeAg+ and HBeAg- patient s for the first week, but was subsequently indistinguishable after wee k 1. After 3 months, the half-life was statistically less for HBeAg+ p atients, but the difference did not influence the clinical treatment r egimens, Quantitative hepatitis B DNA levels did not predict the amoun t of HBIG required, HBV recurrence after orthotopic Liver transplantat ion can be reduced by aggressive passive immunization. Pharmacokinetic analysis of anti-HBs elimination can improve immunoglobulin therapy a nd prevent recurrence of clinical hepatitis.