HBsAg level at time of liver transplantation determines HBsAg decrease and anti-HBs increase and affects HBV DNA decrease during early immunoglobulin administration.

摘要

BACKGROUND/AIMS: Administration of hepatitis B immunoglobulin (HBIG) initially after liver transplantation of hepatitis B patients is considered important to prevent reinfection reliably. However, dosing schedules differ considerably between centers. We measured HBsAg, anti-HBs and HBV DNA kinetics to create a rational basis for dosing schemes. METHODS: Thirteen patients (group A) received 10,000IU HBIG in the anhepatic phase followed by 10,000IU daily until HBsAg became negative, whereas five patients (group B) received 20,000IU followed by 5000IU every 30min. RESULTS: HBsAg levels at time of transplantation ranged from 0.12 to 12,990IU/ml. Correlations between initial HBsAg and HBIG required to decrease HBsAg below 1IU/ml were high in groups A and B (r=0.97, p<0.001; r=1.00, p<0.001), as were correlations between initial HBsAg and HBIG required to raise anti-HBs above 1000IU/l (r=0.94, p<0.001; r=1.00, p<0.001). In 11 HBV DNA-positive patients, DNA levels became negative in seven, and dropped by 2.5 log(10) (mean) in the other four patients during immunoglobulin administration. CONCLUSIONS: In conclusion, required HBIG doses to decrease HBsAg and raise anti-HBs are determined by HBsAg levels at time of transplantation, not by HBV DNA levels. Shortened HBIG dosing intervals accelerate HBsAg decrease and anti-HBs increase. HBV DNA decreases rapidly during HBIG administration in most patients.