Prevention of hepatitis B rerecurrence after a second liver transplant : the role of maintenance polyclonal HBIG therapy

The experience with orthotopic liver transplantation (OLTx) for hepatitis B virus (HBV)-associated chronic liver disease has been disappointing. Recurrent HBV infection, particularly in patients with evidence of active viral replication (HBV DNA- or HBeAg-positive) prior to transplantation, is generally the rule and is associated with high rates of morbidity and mortality due to failure of the allograft. Strategies for prophylaxis or treatment of recurrent infection have been unsuccessful, although there is evidence that passive immunoprophylaxis with hepatitis B immune globulin (HBIG) may delay viral recurrence after transplantation. We describe here a patient who, after experiencing allograft failure due to recurrent HBV, has been treated with HBIG indefinitely following retransplantation.