Conversion from intravenous to intramuscular hepatitis B immune globulin in combination with lamivudine is safe and cost-effective in patients receiving long-term prophylaxis to prevent hepatitis B recurrence after liver transplantation

Steven Huy Han, Paul Martin, Marc Edelstein, Gregg Kunder, Curtis Holt, Sammy Saab, Francisco Durazo, Leonard Goldstein, Douglas Farmer, Rafik M. Ghobrial, Ronald W. Busuttil

Research output: Contribution to journalArticle

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Abstract

Recurrent hepatitis B infection after liver transplantation was previously frequent and associated with significant allograft failure and mortality. Recurrence rates of hepatitis B were improved with the use of passive immunoprophylaxis with hepatitis B immune globulin, and later, lamivudine monotherapy. Combination prophylaxis with intravenous hepatitis B immune globulin and lamivudine substantially decreased rates of hepatitis B recurrence, but intravenous administration of hepatitis B immune globulin was expensive and associated with significant adverse effects. In the current study, 59 patients receiving primary liver transplantation for chronic hepatitis B infection were prospectively followed up after converting from intravenous to intramuscular hepatitis B immune globulin in combination with lamivudine. All patients tolerated intramuscular hepatitis B immune globulin well. At a median follow-up of 511 days after conversion to intramuscular hepatitis B immune globulin, 58 of 59 patients (98.3%) were hepatitis B surface antigen-negative. Twenty-one patients (35.6%) required a median of one supplemental intravenous hepatitis B immune globulin infusion to maintain therapeutic antibody levels. Economic analysis showed an average cost-effectiveness ratio for combination intramuscular hepatitis B immune globulin plus lamivudine of $52,600 per recurrence prevented, which was far below the cost of lamivudine monotherapy and of intravenous hepatitis B immune globulin alone or in combination with lamivudine. These results suggest that intramuscular administration of hepatitis B immune globulin in combination with lamivudine offers a safe, effective, and cost-effective approach to preventing hepatitis B recurrence after orthotopic liver transplantation.

Original languageEnglish
Pages (from-to)182-187
Number of pages6
JournalLiver Transplantation
Volume9
Issue number2
DOIs
StatePublished - Feb 1 2003
Externally publishedYes

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Lamivudine
Hepatitis B
Liver Transplantation
Immunoglobulins
Costs and Cost Analysis
Recurrence
Chronic Hepatitis B
Hepatitis B Surface Antigens
Infection
Intravenous Administration
Cost-Benefit Analysis
Allografts

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Conversion from intravenous to intramuscular hepatitis B immune globulin in combination with lamivudine is safe and cost-effective in patients receiving long-term prophylaxis to prevent hepatitis B recurrence after liver transplantation. / Han, Steven Huy; Martin, Paul; Edelstein, Marc; Kunder, Gregg; Holt, Curtis; Saab, Sammy; Durazo, Francisco; Goldstein, Leonard; Farmer, Douglas; Ghobrial, Rafik M.; Busuttil, Ronald W.

In: Liver Transplantation, Vol. 9, No. 2, 01.02.2003, p. 182-187.

Research output: Contribution to journalArticle

Han, Steven Huy ; Martin, Paul ; Edelstein, Marc ; Kunder, Gregg ; Holt, Curtis ; Saab, Sammy ; Durazo, Francisco ; Goldstein, Leonard ; Farmer, Douglas ; Ghobrial, Rafik M. ; Busuttil, Ronald W. / Conversion from intravenous to intramuscular hepatitis B immune globulin in combination with lamivudine is safe and cost-effective in patients receiving long-term prophylaxis to prevent hepatitis B recurrence after liver transplantation. In: Liver Transplantation. 2003 ; Vol. 9, No. 2. pp. 182-187.
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abstract = "Recurrent hepatitis B infection after liver transplantation was previously frequent and associated with significant allograft failure and mortality. Recurrence rates of hepatitis B were improved with the use of passive immunoprophylaxis with hepatitis B immune globulin, and later, lamivudine monotherapy. Combination prophylaxis with intravenous hepatitis B immune globulin and lamivudine substantially decreased rates of hepatitis B recurrence, but intravenous administration of hepatitis B immune globulin was expensive and associated with significant adverse effects. In the current study, 59 patients receiving primary liver transplantation for chronic hepatitis B infection were prospectively followed up after converting from intravenous to intramuscular hepatitis B immune globulin in combination with lamivudine. All patients tolerated intramuscular hepatitis B immune globulin well. At a median follow-up of 511 days after conversion to intramuscular hepatitis B immune globulin, 58 of 59 patients (98.3{\%}) were hepatitis B surface antigen-negative. Twenty-one patients (35.6{\%}) required a median of one supplemental intravenous hepatitis B immune globulin infusion to maintain therapeutic antibody levels. Economic analysis showed an average cost-effectiveness ratio for combination intramuscular hepatitis B immune globulin plus lamivudine of $52,600 per recurrence prevented, which was far below the cost of lamivudine monotherapy and of intravenous hepatitis B immune globulin alone or in combination with lamivudine. These results suggest that intramuscular administration of hepatitis B immune globulin in combination with lamivudine offers a safe, effective, and cost-effective approach to preventing hepatitis B recurrence after orthotopic liver transplantation.",
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