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Open Access Research article

Hyperimmune anti-HBs plasma as alternative to commercial immunoglobulins for prevention of HBV recurrence after liver transplantation

Florian Bihl1*, Stefan Russmann2, Vanina Gurtner3, Loriana Di Giammarino4, Loredana Pizzi-Bosman5, Martine Michel5, Andreas Cerny6, Antoine Hadengue1, Pietro Majno7, Emiliano Giostra1, Damiano Castelli3 and Gilles Mentha7

Author Affiliations

1 Department of Gastroenterology and Hepatology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland

2 Division of Clinical Pharmacology and Toxicology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland

3 Red Cross Blood Transfusion Service of Southern Switzerland, Via Tesserete 50, 6900 Lugano, Switzerland

4 General Medicine Outpatient Clinic, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland

5 Blood Transfusion Service, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland

6 Hepatology Service, Clinica Luganese, Via Moncucco 10, 6903 Lugano, Switzerland

7 Transplantation Unit, Department of Visceral Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland

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BMC Gastroenterology 2010, 10:71  doi:10.1186/1471-230X-10-71

Published: 4 July 2010

Abstract

Background

Hepatitis B immune globulins (HBIG) in combination with nucleos(t)ide analogues (NA) are effectively used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, associated treatment costs for HBIG are exceedingly high.

Methods

Fresh frozen plasma obtained from blood donors with high anti-HBs levels (hyperimmune plasma, HIP) containing at least 4,500 IU anti-HBs was used as alternative treatment for HBV recurrence prophylaxis post-LT.

Results

Twenty-one HBV-related LT recipients received HIP starting at transplantation, followed by long-term combination treatment with NA. Mean follow-up time was 4.5 years (range 0.5-12.6) and each patient received on average 8.2 HIP per year (range 5.8-11.4). Anti-HBs terminal elimination kinetic after HIP administration was 20.6 days (range 13.8-30.9), which is comparable to values reported for commercial HBIG products. All 21 patients remained free of HBV recurrence during follow-up and no transfusion-transmitted infection or other serious complication was observed. Seven patients developed reversible mild transfusion reactions. The cost for one HIP unit was US$140; average yearly HBIG treatment cost was US$1,148 per patient, as compared to US$25,000-100,000 for treatment with commercial HBIG.

Conclusion

The results of this study suggest that the use of HIP may be a useful and economical approach for the prevention of HBV recurrence post-LT if used in combination with NA. Additional prospective controlled studies in larger populations are needed to confirm these results.