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

Monitoring serum anti-hepatitis B surface levels during intravenous or intramuscular hepatitis B immune globulin therapy to prevent recurrence of hepatitis B virus infection in liver transplant recipients

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 (US) 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.

Not applicable

Please refer to institutional hepatitis B immune globulin (HBIG) therapy protocol for desirable anti-hepatitis B surface (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.

Not useful for determining previous exposure to hepatitis B virus (HBV) or determining adequate immunity from HBV vaccination; order HBAB/8254 Hepatitis B Surface Antibody, Qualitative/Quantitative, Serum for those situations.  

This test does not provide interpretation of the hepatitis B surface (HBs) antibody level to determine immune status. Order HBAB/8254 Hepatitis B Surface Antibody, Qualitative/Quantitative, Serum for determination of immune status.

Previous hepatitis B infection or vaccination and passively acquired anti-HBs from transfusion of whole blood or plasma can contribute to measurable anti-HBs levels.

Not useful for the diagnosis of acute HBV infection.

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

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

• HBV Infection-Monitoring Before and After Liver Transplantation