Hyperimmune anti-HBs plasma as alternative to commercial immunoglobulins for prevention of HBV recurrence after liver transplantation

• Published in: BMC gastroenterology 2010-07, Vol.10 (1), p.71-71, Article 71
• Main Authors: Bihl, Florian, Russmann, Stefan, Gurtner, Vanina, Di Giammarino, Loriana, Pizzi-Bosman, Loredana, Michel, Martine, Cerny, Andreas, Hadengue, Antoine, Majno, Pietro, Giostra, Emiliano, Castelli, Damiano, Mentha, Gilles
• Format: Article
• Language: English
• Subjects: Adult; Antiviral Agents - therapeutic use; Care and treatment; Cost-Benefit Analysis; Diseases; Drug Therapy, Combination; Female; Follow-Up Studies; Hepatitis B - economics; Hepatitis B - immunology; Hepatitis B - prevention & control; Hepatitis B Antibodies - adverse effects; Hepatitis B Antibodies - economics; Hepatitis B Antibodies - therapeutic use; Hepatitis B virus; Humans; Immunoglobulins; Immunoglobulins - economics; Immunoglobulins - therapeutic use; Liver; Liver Transplantation - immunology; Male; Middle Aged; Patient outcomes; Physiological aspects; Plasma; Prevention; Relapse; Secondary Prevention; Transplantation; Treatment Outcome
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/1471-230X-10-71

Hepatitis B immune globulins (HBIG) in combination with nucleos(t)ide analogues (NA) are effectively used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, associated treatment costs for HBIG are exceedingly high. Fresh frozen plasma obtained from blood donors with high anti-HBs levels (hyperimmune plasma, HIP) containing at least 4,500 IU anti-HBs was used as alternative treatment for HBV recurrence prophylaxis post-LT. Twenty-one HBV-related LT recipients received HIP starting at transplantation, followed by long-term combination treatment with NA. Mean follow-up time was 4.5 years (range 0.5-12.6) and each patient received on average 8.2 HIP per year (range 5.8-11.4). Anti-HBs terminal elimination kinetic after HIP administration was 20.6 days (range 13.8-30.9), which is comparable to values reported for commercial HBIG products. All 21 patients remained free of HBV recurrence during follow-up and no transfusion-transmitted infection or other serious complication was observed. Seven patients developed reversible mild transfusion reactions. The cost for one HIP unit was US$140; average yearly HBIG treatment cost was US$1,148 per patient, as compared to US$25,000-100,000 for treatment with commercial HBIG. The results of this study suggest that the use of HIP may be a useful and economical approach for the prevention of HBV recurrence post-LT if used in combination with NA. Additional prospective controlled studies in larger populations are needed to confirm these results.