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Interpretive Handbook

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Test 87893 :
Hepatitis B Surface Antibody Monitor, Post-Transplant, Serum

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

For patients with chronic hepatitis B virus (HBV) infection (hepatitis B surface antigen-positive), outcomes following liver transplantation for end-stage liver disease are poor. Recurrent HBV disease is common and associated with decreased liver graft and patient survival (approximately 50% at 5 years). Studies have shown administration of hepatitis B immune globulin (HBIG) in the perioperative and early posttransplant periods could delay or prevent recurrent HBV infection in these transplant recipients.

 

Intravenous or intramuscular administration of HBIG has become the standard of care for these liver transplant recipients in most liver transplant programs in the United States since mid-1990. Most therapy protocols administer HBIG in high doses (10,000 IU) during the perioperative period and first week after transplantation, with the goal of achieving serum hepatitis B surface antibody (anti-HBs) levels of >500 mIU/mL. Serial levels of anti-HBs are obtained to determine the pharmacokinetics of HBIG in each patient to guide frequency of HBIG dosing.  

 

There is a high degree of variability in HBIG dosage required to achieve desirable serum anti-HBs levels among transplant recipients during the first few weeks to months after transplantation. Patients who were hepatitis B envelope (HBe) antigen positive before transplantation usually require more HBIG to achieve the target anti-HBs levels, especially in the first week after transplantation.

 

Duration of HBIG therapy varies from 6 months to indefinite among different US liver transplant programs. Protocols providing <12 months of therapy usually combine HBIG with another effective anti-HBV agent such as lamivudine.

 

See HBV Infection-Monitoring Before and After Liver Transplantation in Special Instructions.

Useful For Suggests clinical disorders or settings where the test may be helpful

Monitoring serum anti-hepatitis B surface levels during intravenous or intramuscular hepatitis B immune globulin therapy to prevent hepatitis B virus reinfection in liver transplant recipients with known previous chronic hepatitis B

Interpretation Provides information to assist in interpretation of the test results

Please refer to health care provider's institutional hepatitis B immune globulin (HBIG) therapy protocol for desirable hepatitis B surface antibody (anti-HBs) levels.

 

Studies indicated that serum anti-HBs levels needed to prevent hepatitis B virus reinfection were >500 mIU/mL during the first week after transplantation, >250 mIU/mL during weeks 2 to 12, and >100 mIU/mL after week 12.

 

See HBV Infection-Monitoring Before and After Liver Transplantation in Special Instructions.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

This test is not useful for determining past hepatitis B or immune status after hepatitis B virus vaccination and it does not provide interpretation of the anti-HBs level detected; order HBAB / Hepatitis B Surface Antibody, Qualitative/Quantitative, Serum for those situations.

 

Individuals who have received blood component therapies (eg, whole blood), plasma, or intravenous immunoglobulin infusion in the previous 3 to 6 months may have false-positive anti-HBs results due to passive transfer of anti-HBs present in these products. 

 

Performance characteristics have not been established for the following specimen characteristics:

-Grossly icteric (total bilirubin level of >20 mg/dL)

-Grossly lipemic (triolein level of >3,000 mg/dL)

-Grossly hemolyzed (hemoglobin level of >500 mg/dL)

-Containing particulate matter

-Cadaveric specimens

-Heat-inactivated specimens

-Body fluids other than serum (eg, saliva, urine, CSF, amniotic, peritoneal, or pleural fluids)

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Not applicable

Clinical References Provides recommendations for further in-depth reading of a clinical nature

1. Samuel D: Management of hepatitis B in liver transplant patients. Semin Liver Dis 2004;24(suppl 1):55-62

2. Terrault NA, Vyas G: Hepatitis B immune globulin preparations and use in liver transplantation. Clin Liver Dis 2003;7:537-550

3. Lok AS: Prevention of recurrent hepatitis B post-liver transplantation. Liver Transpl 2002;8:S67-S73


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