Aa
A
A
A
Close
Liver Transplant Forum
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Avatar universal

Hepatitis B immune globulin (HBIG)...

Hi Doctor,
For how long is Hbig given, post transplant?
Thank you in advance.
19 Responses
517301 tn?1229797785
MEDICAL PROFESSIONAL
all transplant centers have differerent protocols. We used to give it life-long but now stop after 1 year.  The use of the newer oral agents as monotherapy for prophylaxis has proven effective.
Avatar universal
Is Hepsera (Adefovir Dipivoxil),one of the oral medications you would consider as a good alternative once the Hbig is discontinued being given? Currently taking the Hepsera 10mg one time daily in addition to the Hbig.
Thank you in advance.
517301 tn?1229797785
MEDICAL PROFESSIONAL
i am not aware of hepsera monotherapy being adequate.  there is data on baraclude, truvada and viread
Avatar universal
Would the medications you mentioned (baraclude, truvada and viread) be taken in ADDITION to the Hepsera (once the Hbig is discontinued)? Why isn't the Hepsera adequate enough?
Thank you in advance.
517301 tn?1229797785
MEDICAL PROFESSIONAL
the mutation rate is higher with hepsera which is why the others have been studied more.  we used to overlap the two medications but frankly we are now just directly converting patients to truvada mostly.
Avatar universal
Are there any other medications besides Truvada that you would consider? If the Hepsera has been used long term (began using prior to transplant) why wouldn't a patient continue to stay on that particular regimen?
Thank you in advance.
517301 tn?1229797785
MEDICAL PROFESSIONAL
potentially it could be used as a monotherapy but the risk of mutation development is higher than with truvada, viread and baraclude.
Avatar universal
Do you recommend the truvada over the viread or baraclude?  If while being switched from Hepsera to truvada is there a risk that the Hep B could become active? Also , the Hepatitis B DNA is currently undetectable and the Hep B Surface AG is currently negative  (both prior to transplant as well as post transplant, so far ) what are the chances that the Hep B could become active again once the Hbig infusions are stopped? Thank you.
517301 tn?1229797785
MEDICAL PROFESSIONAL
there doesnt need to be an overlap period between the 2 medications.  any of these to be switched to is OK.  I am not sure though frankly why you need any treatment at all if your HBSAg was (-) prior to the btransplant
Avatar universal
Not sure, maybe as a precaution?  
1. Are you referring to why being given the Hbig and Hepsera, post transplant since the HBSAg was negative prior to transplant?
2. Does the Hepsera or any of the other medications you mention (Viread or Baraclude) need to be taking if the HBSAg is negative or only if its positive? 3. What exactly does the "surface antigen" indicate? I have always been a bit confused with Antigen versus Antibody.
4. Can the HBSAg ever become positive again once the Hbig is no longer given?
5. Are the Hepsera, Viread or Baraclude life long medications?

Greatly appreciate you taking the time to help me with my questions.
517301 tn?1229797785
MEDICAL PROFESSIONAL
if you didnt have HSAg (+) before the transplant you didnt have HBV so wouldnt need prophylaxis post-transplant.  any of these oral medications would be life-long.  The HBSAg could become (+) again but that would constitute a recurrence
Avatar universal
Does Hepatitis  B have a history of coming back Post transplant? I read a lot about reoccurance with Hep C. Does Hep B follow that pattern?
517301 tn?1229797785
MEDICAL PROFESSIONAL
it can come back, but extremely unlikely if the patient is receiving some sort of prophylaxis
Avatar universal
How often do you recommend testing the Hep B surface antigen, Hep B surface antibody and Hep B DNA Quant?
If the Hepsera contributed to the Hep B becoming non-active prior to transplant , could it still be used (post transplant)once the Hbig is discontinued? Or should Viread or Baraclude be considered?
Thank you.
517301 tn?1229797785
MEDICAL PROFESSIONAL
you can continue the baraclude.  we typically check the HBV labs every 4 months.
Avatar universal
Do you mean the "Hepsera "?
517301 tn?1229797785
MEDICAL PROFESSIONAL
yes
Avatar universal
Thank you .
Avatar universal
hi doctor i have hbv-hdv cirhosis and i will be needing a liver transplant in two year time.
just wanted to ask that if these viruses come back after transplant and damages the new liver  because i have heard a lot of hcv recurrrence?
also what do you say about the survival after liver transplant?
Popular Resources
For people with Obsessive-Compulsive Disorder (OCD), the COVID-19 pandemic can be particularly challenging.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Here’s how your baby’s growing in your body each week.
These common ADD/ADHD myths could already be hurting your child
This article will tell you more about strength training at home, giving you some options that require little to no equipment.
In You Can Prevent a Stroke, Dr. Joshua Yamamoto and Dr. Kristin Thomas help us understand what we can do to prevent a stroke.