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23. What is the prophylaxis treatment to prevent hepatitis B (HBV) recurrence after transplant?

As long as they use the right combination of protocols to prevent recurrence. The way we do it is right at the time of transplant, we give them a big dose of hepatitis B immune globulin (HBIG), and we keep up the dose for about 7 days, and we also give some lamivudine. In the population that does not have a high viral load, just using immune globulin will cause a very low recurrence rate. But HBIG is expensive. But if you just use lamivudine without HBIG, the recurrence rate is much higher, so you have to use the HBIG. You are looking for a certain level of HBIG in the blood, and very often with patients, after one or two years, you can drop the dose to maybe once every 6 weeks.