Improved outcome of orthotopic liver transplantation for chronic hepatitis B cirrhosis with aggressive passive immunization

Robert W. Mcgory, Michael B. Ishitani, Walter M. Oliveira, William C. Stevenson, Christopher S. Mccullough, Rolland C. Dickson, Stephen H. Caldwell, Timothy L. Pruett

Research output: Contribution to journalArticlepeer-review

264 Scopus citations


Passive immunization with hepatitis B surface antibody (anti-HBs) is important to prevent hepatitis B virus (HBV) recurrence after orthotopic liver transplantation for chronic HBV cirrhosis. Hepatitis B immune globulin (HBIG) dosing regimens have been poorly defined, utilize numerous routes of administration, and result in a high rate of HBV relapse and mortality. Twenty-five of 27 (93%) patients transplanted (four retransplants) for chronic HBV cirrhosis show no evidence of recurrent HBV (range, 2-55 months). Anti-HBs titers necessary to minimize the risk of hepatitis B surface antigen detectability were >500 IU/L for days 0 to 7, >250 IU/L for days 8 to 90, and >100 IU/L thereafter. Pretransplant HBV E antigen (HBeAg)-positive patients required more HBIG to achieve these goals than HBeAg-negative individuals. The elimination of 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-HBs elimination was significantly different in HBeAg+ and HBeAg- patients for the first week, but was subsequently indistinguishable after week 1. After 3 months, the half-life was statistically less for HBeAg+ patients, but the difference did not influence the clinical treatment regimens. Quantitative hepatitis B DNA levels did not predict the amount of HBIG required. HBV recurrence after orthotopic liver transplantation can be reduced by aggressive passive immunization. Pharmacokinetic analysis of anti- HBs elimination can improve immunoglobulin therapy and prevent recurrence of clinical hepatitis.

Original languageEnglish (US)
Pages (from-to)1358-1364
Number of pages7
Issue number9
StatePublished - May 15 1996

ASJC Scopus subject areas

  • Transplantation


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