Please use this identifier to cite or link to this item:
Title: Combination low-dose hepatitis B immune globulin and lamivudine therapy provides effective prophylaxis against posttransplantation hepatitis B.
Austin Authors: Angus, Peter W ;McCaughan, Geoffrey W;Gane, E J;Crawford, D H;Harley, H
Affiliation: Victorian Liver Transplant Unit
Issue Date: 1-Jul-2000
Publication information: 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.
DOI: 10.1053/jlts.2000.8310
Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Type: Journal Article
Subjects: Adult
Combined Modality Therapy
Drug Therapy, Combination
Hepatitis B.prevention & control
Hepatitis B virus.isolation & purification
Immunization, Passive
Immunoglobulins.administration & dosage.economics.therapeutic use
Immunoglobulins, Intravenous.therapeutic use
Lamivudine.therapeutic use
Liver Transplantation.mortality
Middle Aged
Postoperative Complications.prevention & control
Secondary Prevention
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Apr 12, 2024

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.