Intramuscular hepatitis B immune globulin combined with lamivudine for prophylaxis against hepatitis B recurrence after liver transplantation

Immunoprophylaxis using intravenous (IV) hepatitis B immune globulin (HBIG) decreases the recurrence of hepatitis B virus (HBV) infection after orthot opic liver transplantation (OLT), However, IV HBIG is expensive, has signif icant side effects, and is inconvenient to administer. An alternative appro ach for prophylaxis using intramuscular (IM) HBIG and oral lamivudine was p rospectively evaluated in this study. Ten consecutive patients with cirrhos is with HBV infection who underwent OLT were included in this study. Nine o f 10 patients received lamivudine, 150 mg/d, for an average duration of 8.6 months before OLT. Two of 10 patients with detectable HBV DNA at the time of OLT received 10,000 U (45 mt) of IV HBIG daily for 7 consecutive days, f ollowed by 5 mt of IM HBIG weekly for the next 3 weeks, then every 3 weeks. The other 8 patients were HBV DNA negative at OLT and received one dose of IV HBIG (45 mt) during surgery, followed by 5 mt of IM HBIG weekly for 4 w eeks, then every 3 weeks. Ail patients received lamivudine, 150 mg/d, after OLT, During a mean follow-up of 15.6 months, 9 of 10 patients achieved a p rotective hepatitis B surface antibody (HBsAb) titer greater than 200 IU/L and had no evidence of HBV recurrence. One patient failed to develop an ade quate HBsAb titer and developed histological and virological evidence of re currence. One patient died unrelated to HBV recurrence. Our preliminary dat a suggest that this combination prophylaxis with IM HBIG and lamivudine is effective and potentially cost saving. Copyright (C) 1999 by the American A ssociation for the Study of Liver Diseases.