Recipient demographics, including age, race, gender, and transplant indication, were obtained from electronic medical records

Recipient demographics, including age, race, gender, and transplant indication, were obtained from electronic medical records. recipients; 39 (73.6%) were male with a median age of 59 y. HCV was the major indication in 30 (55.6%) patients. There were 28 recipients (52.8%) who received HBIG plus AV and 25 (47.2%) received AV only. The Model of End Stage Liver Disease (MELD) score between the groups were similar. Garcinone D Survival rates at 6, 12, and 24 months were 100% (n=53), 93.2% (n=44), and 100.0% (n=26), respectively. There was no reactivation; two recipients in the AV group and one in the HBIG plus AV group died within 12 months. == Conclusion == This study supports the use of low-dose HBIG and AV for post-LT prophylaxis to be as effective as conventionally used high-dose HBIG (9600 IU) plus AV. Future prospective larger studies are warranted to examine the potential benefits of using AV alone without HBIG. Keywords:Hepatitis B, liver transplant, recurrence, prophylaxis == INTRODUCTION == Hepatitis B is usually a universal health problem. In the United States, approximately 800,0001.4 million people are chronically infected with Hepatitis B virus (HBV) and 3000 per year die from HBV-related diseases (1). The transmission risk is usually 25%-60% in healthy patients and those who are infected through Garcinone D exposure to people who are positive for Hepatitis B surface antigen (HBsAg) and Garcinone D Hepatitis B e antigen (HBeAg) (2). Five-year survival rates in HBV patients with compensated and decompensated cirrhosis are 84% and 14%, respectively (3). The HBsAg and Hepatitis B core antibody (HBcAb) status of an organ donor or recipient determine the risk of contamination and transmission of HBV following transplantation. The rate of HBV liver transplantation (LT) failure was high in the 1980s when there was no pre- and post-LT HBV treatment (35). The high rates of post-LT mortality from HBV in the 1980s underlined the Garcinone D importance of treatment and reactivation prevention of HBV. Seropositive HbcAb IgG is usually evidence of Garcinone D past exposure to HBV. HBcAb-positive donors and recipients are at a risk of reactivation and reinfection, especially during the early post-LT phase. The risk of reinfection is related to immunosuppression in the post-LT phase, leading to enhanced viral replication of the HBV genome and growth of extrahepatic reservoirs of HBV (6,7). The prognosis for HBV patients during the pre-Hepatitis B immunoglobulin (HBIG) era was not promising. The introduction of HBIG, followed by antivirals (AV), gave hope to these patients. The prophylactic use of HBIG alone resulted in 1- and 5-12 months post-LT survival rates as high as 85% and 75%, respectively; less than 5% graft reinfections was also observed (8,9). HBIG use as prophylaxis was based on the hypothesis that antibodies to HBsAg would bind and neutralize the circulating virions and reduce HBsAg secretion, thereby preventing graft contamination (10). The combined use of HBIG and AV now has become the standard of care. However, HBIG typically costs patients about $30,000-$50,000 per year when given intravenously for the first week and monthly thereafter (11). In addition to cost, side effects from these regimens include headache, flushing, muscle ache, and lactic acidosis (12). Because of limitations in access, high cost, and side effects of HBIG therapy, various groups have developed alternative regimens that are effective and are associated with lower cost. The duration, dosage, and route of HBIG administration may vary according to local Rabbit polyclonal to ZNF512 clinical practice (13). It has been postulated that HGIB can be discontinued both 1 month or 1 year post-transplant (1417). Fung et al. (15) followed 80 patients with chronic HBV who received entecavir therapy without HBIG, and after 2 years post-transplant, most of the recipients have their lost HBsAg. Teperman et al. (18) also showed that dual therapy with two different AVs can be as effective as combination therapy of HBIG with one or two AVs after a limited period of HBIG. These.