Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/9237
Title: Combination low-dose hepatitis B immune globulin and lamivudine therapy provides effective prophylaxis against posttransplantation hepatitis B.
Authors: Angus, Peter W;McCaughan, Geoffrey W;Gane, E J;Crawford, D H;Harley, H
Affiliation: Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, South Australia, Australia. pangus@patash.com.au
Issue Date: 1-Jul-2000
Citation: Liver Transplantation : Official Publication of the American Association For the Study of Liver Diseases and the International Liver Transplantation Society; 6(4): 429-33
Abstract: Although antiviral prophylaxis with lamivudine monotherapy appears to reduce post-liver transplantation recurrence of hepatitis B virus (HBV) infection, breakthrough infections occur in at least 20% of the patients because of the development of drug resistance. Combined lamivudine and intravenous hepatitis B immune globulin (HBIG) therapy (10,000-IU doses) may reduce this risk, but its use is limited by cost ( approximately US $45,000/yr) and availability. We report the experience at liver transplant centers in Australia and New Zealand in which lamivudine has been used in combination with much lower doses of HBIG than used in conventional HBIG prophylaxis. Lamivudine, 100 mg/d, was administered to hepatitis B surface antigen (HBsAg)-positive candidates on listing for transplantation and was continued posttransplantation. HBIG, 400 or 800 IU, was administered intramuscularly (IM) daily for 1 week from transplantation and monthly thereafter. Thirty-seven HBsAg-positive patients underwent transplantation using this protocol. Thirty-six of these patients were HBV DNA positive by polymerase chain reaction (PCR) or hybridization assay. Thirty-four patients had chronic HBV, 2 patients had hepatitis B and C, and 1 patient had hepatitis B, C, and D. Five patients died within 1 month of transplantation and are not included in the analysis. Mean follow-up in the remaining 32 patients was 18.4 months (range, 5 to 45 months). Treatment was well tolerated, with no significant adverse events. Thirty-one of 32 patients were HBsAg negative, and all 32 patients were HBV DNA negative by PCR at latest follow-up. The cost of treatment was US $967 for lamivudine and between $2,290 and $4,480/yr for IM HBIG. Lamivudine and low-dose HBIG treatment prevents posttransplantation recurrence of hepatitis B and is likely to be more cost-effective than high-dose HBIG regimens.
Internal ID Number: 10915163
URI: http://ahro.austin.org.au/austinjspui/handle/1/9237
DOI: 10.1053/jlts.2000.8310
URL: http://www.ncbi.nlm.nih.gov/pubmed/10915163
Type: Journal Article
Subjects: Adult
Combined Modality Therapy
Drug Therapy, Combination
Female
Hepatitis B.prevention & control
Hepatitis B virus.isolation & purification
Humans
Immunization, Passive
Immunoglobulins.administration & dosage.economics.therapeutic use
Immunoglobulins, Intravenous.therapeutic use
Lamivudine.therapeutic use
Liver Transplantation.mortality
Male
Middle Aged
Postoperative Complications.prevention & control
Secondary Prevention
Appears in Collections:Journal articles

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