Prevention of Hepatitis B Recurrence in Liver Transplant Patients Using Oral Antiviral Therapy with Long-Term Low and High Dose Hepatitis B Immunoglobulin (Karacier nakli yap' lan hastalarda Hepatit B nüksünü engellemek amac' yla kullan' lan oral antiviral tedaviye eklenen Hepatit B immunoglobulin tedavisinin dü˙ük doz uzun dönem ile yüksek dozunun kar˙' lat' r' lmas' )

Background: Hepatitis B virus (HBV) related orthotropic liver transplant (OLT) recipients have a high risk of HBV reinfection in the absence of continuous post-operative HBV prophylaxis. The combination of hepatitis B immune globulin (HBIG) and nucleos(t)ide agents is currently recommended as prophylaxis against the recurrence of HBV after OLT. However optimal protocol is a matter of controversy. The aim of this study was to investigate the efficacy of nucleos(t)ide analogue with long-term low and high dose HBIG therapy after OLT at a single organ transplant center. Material and Methods: Forty-two HBV patients undergoing OLT at a transplant center of Akdeniz University between 2000 and 2012 were evaluated. 24 patients received low-dose (2 000 IU) IV HBIG, 18 Patients received high dose (10 000 IU) IV HBIG in anhepatic phase. In long-term period patients were divided into two groups. First group of patients had hepatitis B surface antibody titers more than 100 IU/dl HBIG and second group of patients had less than 100 IU/dl HBIG titers. Results: Twenty-four patients were treated with low dose HBIG, on the other hand 18 patients were treated with high dose HBIG prophylaxis in the follow-up period. Four patients could not continue the HBIG prophylaxis. In three of four patients, HBV appeared. At a median time of 33 months (range 2-110 months) post-LT, 4 of the 38 patients had recurrent HBV infection. Patients receiving high dose HBIG and an oral antiviral agent have a lower frequency of HBV recurrence after OLT. Conclusions: Nucleosi(t)de analogue therapy was effective and safe to prevent post-LT HBV recurrence. However, combination of long-term high dosage of HBIG and nucleos(t)ide antiviral agents for HBV prophylaxis significantly reduces the risk of HBV recurrence after OLT.