Abate HM, Byrns J, Martschenko A, King LY, Wegermann K. Hepatitis B immune globulin to prevent hepatitis B recurrence after liver transplant: A single-center experience. World J Clin Infect Dis 2026; 15(1): 122164 [DOI: 10.5495/wjcid.122164]
Corresponding Author of This Article
Kara Wegermann, MD, Assistant Professor, Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, United States. kara.wegermann@duke.edu
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Abate HM, Byrns J, Martschenko A, King LY, Wegermann K. Hepatitis B immune globulin to prevent hepatitis B recurrence after liver transplant: A single-center experience. World J Clin Infect Dis 2026; 15(1): 122164 [DOI: 10.5495/wjcid.122164]
World J Clin Infect Dis. Sep 8, 2026; 15(1): 122164 Published online Sep 8, 2026. doi: 10.5495/wjcid.122164
Hepatitis B immune globulin to prevent hepatitis B recurrence after liver transplant: A single-center experience
Hiwot M Abate, Jennifer Byrns, Alec Martschenko, Lindsay Y King, Kara Wegermann
Hiwot M Abate, Department of Gastroenterology, Carillon Clinic, Roanoke, VA 24014, United States
Jennifer Byrns, Alec Martschenko, Department of Pharmacy, Duke University Hospital, Durham, NC 27710, United States
Lindsay Y King, Kara Wegermann, Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States
Author contributions: Wegermann K, Byrns J, and Martschenko A designed the study; Wegermann K supervised the project; Abate HM performed data collection and analysis, wrote the manuscript; all authors revised the manuscript.
Institutional review board statement: The study was approved by our center’s Institutional Review Board (No. 00114976) and received a waiver of informed consent.
Informed consent statement: The study received a waiver of informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: De-identified data that support the findings of this study are available from the corresponding author upon reasonable request, subject to institutional and IRB approval.
Corresponding author: Kara Wegermann, MD, Assistant Professor, Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, United States. kara.wegermann@duke.edu
Received: April 13, 2026 Revised: April 21, 2026 Accepted: May 14, 2026 Published online: September 8, 2026 Processing time: 149 Days and 12.1 Hours
Abstract
BACKGROUND
Hepatitis B surface antigen (HBsAg) positive liver transplant (LT) recipients are at an increased risk for hepatitis B virus (HBV) recurrence without prophylaxis with hepatitis B immune globulin (HBIG), nucleos(t)ide analogue, or a combination.
AIM
To describe the use of HBIG in HBsAg positive LT recipients and explore the association between HBIG duration and HBV recurrence.
METHODS
We performed a retrospective, single-center cohort study of HBsAg positive LT recipients between January 1, 2016 and July 31, 2023. A descriptive statistical analysis was performed. The primary outcome was HBV virologic recurrence at 12 months post-LT, defined as HBV DNA > 100 IU/mL.
RESULTS
A total of 14 LT recipients (64% males, median age 59 years) were included. Reasons for LT were cirrhosis with hepatocellular carcinoma (n = 5), other complications of cirrhosis (n = 6), and acute liver failure (n = 3). Ten patients received HBIG after LT, with treatment duration ranging from 5 days to 12 months. All patients had HBV DNA < 100 IU/mL by 2 months post-LT. Of the 14 patients, 12 had HBV DNA < 20 IU/mL at either 6 or 12 months post-LT. None of the patients developed HBsAg positivity post-LT.
CONCLUSION
In this small, single-center cohort, shorter durations of HBIG (≤ 6 months) were not associated with HBV recurrence. These findings suggest that time-limited HBIG may be feasible in selected HBsAg-positive LT recipients, but should be interpreted with caution and require validation in larger, prospective studies.
Core Tip: We studied liver transplant (LT) recipients with chronic hepatitis B, who are often given long durations of hepatitis B immune globulin (HBIG) to prevent hepatitis B recurrence, and found that as little as 6 months of HBIG effectively suppressed hepatitis B DNA and prevented recurrence. Our findings have the potential to reduce cost, side effects, and inconvenience for LT recipients with hepatitis B without compromising patient safety.
