Rationality analysis of delivery method for hepatitis B immune globulin in patients with chronic HBV infection after liver transplantation

Objective To analyze the rationality of delivery method for hepatitis B immune globulin ( HBIG) in patients with chronic hepatitis B virus ( HBV) infection after liver transplantation and to investigate the guiding principle for medication. Methods Forty- four cases of hepatitis B- related liver transplantation who participated in the phase IV clinical trial of HBIG for intravenous injection from August 2008 to December 2010 were analyzed. These patients were divided into severe liver disease group, liver cancer group, and liver cirrhosis group. The positive rates of HBV DNA and HBeAg were compared between groups by chi- square test. The HBV DNA level was compared by analysis of variance. The correlation between blood concentration and half- life of HBIG at different doses and dosing intervals was analyzed by Pearson's correlation test. The titer of anti- HBs at one week after operation was compared between HBeAg- negative group and HBeAg-positive group and between high- HBV DNA group and low- HBV DNA group by t test. Cases of reinfection were also monitored. Results There were no significant differences in the positive rates of HBV DNA and HBeAg between the severe liver disease group, liver cancer group, and liver cirrhosis group ( χ2= 4. 871, P = 0. 088; χ2= 1. 079, P = 0. 583) . No significant differences in mean HBV DNA level were found between these groups ( F = 0. 895, P = 0. 418) . The Pearson's correlation analysis revealed a significant negative correlation between the blood concentration and half- life of HBIG ( r = 0. 988, P = 0. 012) . The tier of anti- HBs showed no significant differences between HBeAg- negative group and HBeAg- positive group and between high- HBV DNA group and low- HBV DNA group one week after operation ( t = 1. 757, P = 0. 087) . No cases of reinfection were found during the observation period. Conclusion It is necessary to give HBIG 4000 IU during operation and 2000 IU daily for 6 days after operation, and the dose should be increased appropriately when the patients have relatively high viral load in serum. For the patients whose serological markers of hepatitis B become negative, the antibody level can be maintained at about 100 IU / L until the next administration if 600 IU of HBIG is given once a month by intramuscular injection.