Evaluating the Use of Hepatitis B Immunoglobulin After Liver Transplant.

Current guidelines differ on the duration that hepatitis B immunoglobulin (HBIG) therapy should be offered after liver transplant for hepatitis B. Most guidelines state that selected patients who are considered at low risk of recurrence could discontinue HBIG therapy 6 to 12 months posttransplant. At Vancouver General Hospital, a cohort of patients remains on HBIG therapy long term. The aim of this audit was to evaluate whether we are following the proposed guidelines established by several organizations (American Association for the Study of Liver Diseases, European Association for the Study of the Liver, Canadian Association for the Study of the Liver). Our unit maintains a database of all patients currently on HBIG therapy since the inception of the program. This database was accessed, and all patients currently receiving HBIG therapy were included in the audit. The cases were manually reviewed, and data were collected for date of transplant, indication for transplant, presence of hepatocellular carcinoma in explant, hepatitis B virus DNA level at the time of transplant, presence of HIV or hepatitis D virus coinfection, hepatitis B serology, any episodes of relapse, and which antiviral the patient was taking. Twenty-two patients were included in the audit. Eight patients (36%) have been identified who are currently receiving HBIG therapy that could be ceased. Three patients developed a recurrence of hepatitis B surface antigen on lamivudine. These patients could be changed to tenofovir and have their HBIG ceased with monitoring as per protocol. This project demonstrates that patients receiving HBIG therapy should be more regularly reviewed for consideration of cessation, in line with the guidelines.