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Prophylaxis of hepatitis B recurrence after liver transplantation
Adult: Initially, 20,000 IU peri-operatively, then 20,000 IU once daily from day 1-7 post-surgery, then once every 2 weeks starting day 14, then once every month starting on month 4 post-surgery. All doses are given via IV infusion. Adjust the dose to reach anti-HBs level of 500 IU/L within the 1st week post-transplant. Alternatively, 10,000 IU peri-operatively, then 2,000-10,000 IU daily for 7 days, then as necessary to maintain antibody levels >100-150 IU/L in HBV-DNA negative patients and above 500 IU/L in HBV-DNA positive patients. There are variabilities in the contents of hepatitis B immunoglobulin between manufacturers as well as the immunisation program among countries. Refer to individual product and local guidelines.
Parenteral
Passive immunisation against hepatitis B infection
Adult: ≥500 IU (according to the intensity of exposure) as a single dose given via IM inj or IV infusion within 24-72 hours (up to 1 week) after exposure. Alternatively, 12-20 IU/kg or 0.06 mL/kg via IM inj within 24 hours of exposure (e.g. mucosal, ocular, needlestick) or within 14 days of sexual exposure. There are variabilities in the contents of hepatitis B immunoglobulin between manufacturers as well as the immunisation program among countries. Refer to individual product and local guidelines.
Child: Perinatal exposure in newborn infants whose mothers are carriers of hepatitis B surface antigen or HBsAg-positive: 30-100 IU/kg via IV infusion or IM inj (depending on product used), preferably within 12-24 hours of birth. Alternatively, 100 IU via IM inj at birth. Postexposure prophylaxis: <5 years 200 IU; 5-9 years 300 IU as a single dose; >10 years Same as adult dose. There are variabilities in the contents of hepatitis B immunoglobulin between manufacturers as well as the immunisation program among countries. Refer to individual product and local guidelines.
Child: Perinatal exposure in newborn infants whose mothers are carriers of hepatitis B surface antigen or HBsAg-positive: 30-100 IU/kg via IV infusion or IM inj (depending on product used), preferably within 12-24 hours of birth. Alternatively, 100 IU via IM inj at birth. Postexposure prophylaxis: <5 years 200 IU; 5-9 years 300 IU as a single dose; >10 years Same as adult dose. There are variabilities in the contents of hepatitis B immunoglobulin between manufacturers as well as the immunisation program among countries. Refer to individual product and local guidelines.
Subcutaneous
Prophylaxis of hepatitis B recurrence after liver transplantation
Adult: 500-1,000 IU (up to 1,500 IU in some cases) once weekly or once every 2 weeks depending on anti-HBs level. Adequate anti-HBs serum levels should be stabilised with an IV hepatitis B immunoglobulin to levels ≥300-500 IU/L before initiation of SC dose to ensure adequate anti-HBs coverage during the transition from IV to SC. Maintain antibody levels >100 IU/L in HBsAg and HBV-DNA negative patients. There are variabilities in the contents of hepatitis B immunoglobulin between manufacturers as well as the immunisation program among countries. Refer to individual product and local guidelines.
