A study of the pharmacokinetic profile of low dose hepatitis B immune globulin (HBIG) in long-term liver transplant recipients for chronic hepatitis B infection

Context

Post-transplant protocols for HBV prophylaxis using high dose intravenous HBIG (10,000 IU) ± lamivudine are commonly reported. Our centre has previously reported a low dose IM protocol and lamivudine with excellent results. There have been, however, no pharmacokinetic studies of IM HBIG in this setting.

Objectives

Our objective was to determine the pharmacokinetic profile of IM HBIG in long-term post-transplant recipients to determine a rational dosing protocol.

Setting

An outpatient liver transplant clinic at Vancouver General Hospital.

Design

Six patients receiving monthly HBIG IM injections (Nabiâ 1560 IU, n=3; Bay-Hepâ 2170 IU, n=3) for greater than one year were studied. HBIG titers (anti-HBs) were determined three times weekly for four weeks and then twice weekly. The pharmacokinetic parameters were calculated using non-compartment methods.

Main Outcome Measures

The outcome measures were pharmacokinetic parameters for IM HBIG injection in stable liver transplant recipients.

Results

The mean half-life of IM HBIG was approximately 10.5 days (range 4-20).

Conclusions

Based on these pharmacokinetic parameters in stable long-term post-transplant patients, a rational dosing protocol can be developed which allows for more appropriate utility of HBIG and improved patient convenience.

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