The combination of
hepatitis B immunoglobulin (
HBIG) and
antivirals (nucleos[t]ide analogs) has extended the applicability of orthotopic
liver transplantation (OLT) for patients with hepatitis B virus (HBV)-related
liver disease. However,
HBIG administrations have an extremely high cost. Herein, we evaluated our results with low-dose, on-demand, intramuscular
HBIG plus
lamivudine (
LAM) prophylaxis after OLT. The HBV
DNA status in 40 patients at the time of OLT determined the treatment: group A (n = 22), HBV
DNA (-), no
antiviral pretreatment; group B (n = 11), HBV
DNA (-), after
LAM; group C (n = 3), HBV
DNA (+) after
LAM (
LAM resistance/
Adefovir [ADV] unavailable); group D (n = 2), HBV
DNA (+), no
antiviral pretreatment; and group E (n = 2), HBV
DNA (-) after
LAM + ADV (
LAM resistance/ADV available). Five patients died within 12 months after OLT unrelated to HBV
infection. The remaining 35 patients were followed for a median duration of 16 months (range, 6-93 months). Only two recipients from group C, who were transplanted despite
LAM resistance + no ADV pretreatment, revealed recurrent HBV
infections at 14 and 16 months posttransplantation; they were then treated successfully with ADV as it became available. The third group C recipient had undetectable HBV
DNA at 18 months after OLT. The mean cumulative doses of
HBIG administered within the first, second, and third years were 34,014, 5258, and 5090 IU, respectively. In conclusion, low-dose, on-demand, intramuscular
HBIG plus (
LAM +/- ADV) prophylaxis is a safe, efficient, and cost-effective regimen to prevent recurrent HBV
infection following OLT. OLT despite untreated
LAM resistance may require sustained higher serum HBsAb levels after surgery.