Intramuscular injection of hepatitis B immunoglobulin combined with lamivudine to prevent hepatitis B virus reinfection following liver transplantation: An analysis of 35 cases

Aim: To explore the tactic to prevent the reinfection of hepatitis B virus (HBV) after liver transplantation by use of lamivudine combined with intramuscular injection of hepatitis B immunoglobulin (HBIG). Methods: The experiment adopted 35 patients who underwent liver transplantation in the First Hospital of Xi'an Jiaotong University from October 2004 to May 2006. Preoperatively all the subjects were examined to be positive for hepatitis B surface antibody (HBsAb) and/or HBV-DNA, and they received the postoperative prophylaxis of HBV reinfection, which included lamivudine and HBIG. 1 Lamivudine (100 mg/d) was administered orally every day except the day of operation. Preoperative treatment was lasted for over two weeks. HBIG were administered intramuscularly 4 000 U during anhepatic phase, 2 000 U every day during the first postoperative week, and thereafter when necessary to maintain HBsAb titer ≥ 500 U/L within 3 months, ≥ 300 U/L between 4-6 months and ≥ 100 U/L beyond 6 months after operation. During the follow-up, the patients were examined for the liver function, HBV-DNA and liver biopsy. Increasing dose of HBIG combined entacavir were applied when HBV reinfection appeared. 2 The medical records of Japanese patients reported in the literatures were taken as controls, and they were treated with lamivudine and intravenous injection of HBIG. Results: Seven cases were invalid due to the deaths. 1 Thirty-five patients were followed up for an average of (15.09± 6.50) months, including 13 cases for 7-12 months, 8 cases for 13-18 cases, 12 cases for 19-24 months, and 2 cases for over 24 months. 2 The HBV reinfection rate was 5.71% (2/35) in the patients and 0 (0/30) in Japanese controls. There was no significant difference between the two groups (P=0.37). Conclusion: Combined use of lamivudine and HBIG in intramuscular injection according to the HBsAb may be a reasonable strategy for HBV prophylaxis after liver transplantation, and the effect is identical with that of lamivudine and HBIG in intravenous injection.