European hepatitis B immunoglobulin trials: prevention of recurrent hepatitis B after liver transplantation

Orthotopic liver transplantation is used for treatment of liver cirrhosis and organ failure due to chronic hepatitis B infection. However, in the absence of effective antiviral therapy, patients can develop recurrent hepatitis B leading to graft failure. In this report, a review is presented of several European studies that have demonstrated the efficacy of hepatitis B immunoglobulin (HBIg) in lowering the rate of recurrence or the severity of the recurrent infection. Clinical protocols and results of these studies are described in detail. Several important conclusions can be derived from the clinical results. HBIg is most effective when administered in high doses for a long time. Characteristics of the recipients, such as the presence or absence of viral DNA, can also affect the rate of recurrence. Intramuscular injection of HBIg has minimal side effects and results in reduced cost relative to intravenous injection.