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

Reporting Name

HBs Ab Monitor, Post-transplant, S

Useful For

Monitoring serum anti-hepatitis B surface (anti-HBs) levels during intravenous or intramuscular hepatitis B immune globulin (HBIG) therapy to prevent hepatitis B virus (HBV) reinfection in liver transplant recipients with known previous chronic HBV

Testing Algorithm

See HBV Infection-Monitoring Before and After Liver Transplantation in Special Instructions.

Specimen Type

Serum SST


Advisory Information


This test is not useful for determining past hepatitis B or immune status after hepatitis B virus (HBV) vaccination and it does not provide interpretation of the anti-hepatitis B surface (anti-HBs) level detected; order HBAB / Hepatitis B Surface Antibody, Qualitative/Quantitative, Serum for those situations.



Necessary Information


Date of collection is required.



Specimen Required


Collection Container/Tube: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Centrifuge blood collection tube per collection tube manufacturer's instructions.

2. Aliquot serum into plastic vial.


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum SST Frozen (preferred) 28 days
  Refrigerated  7 days
  Ambient  24 hours

Reference Values

Not applicable

Day(s) and Time(s) Performed

Monday through Saturday; Varies

Test Classification

This test has been cleared, approved or is exempt by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86317

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HBABT HBs Ab Monitor, Post-transplant, S 32019-2

 

Result ID Test Result Name Result LOINC Value
HBABT HBs Ab Monitor, Post-transplant, S 32019-2

Clinical Information

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 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 above 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 e (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 less than 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.

Interpretation

Please refer to health care provider's institutional hepatitis B immune globulin (HBIG) therapy protocol for desirable hepatitis B surface antibody (anti-HBs) levels.

 

Studies indicated that serum anti-HBs levels needed to prevent hepatitis B virus (HBV) reinfection were greater than 500 mIU/mL during the first week after transplantation, greater than 250 mIU/mL during weeks 2 to 12, and greater than 100 mIU/mL after week 12.

 

See HBV Infection-Monitoring Before and After Liver Transplantation in Special Instructions.

Clinical Reference

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 Aug;7(3):537-550

3. Lok AS: Prevention of recurrent hepatitis B post-liver transplantation. Liver Transpl. 2002;8:S67-S73

4. Levitsky J, Doucette K, AST Infectious Diseases Community of Practice: Viral hepatitis in solid organ transplant recipients. Am J Transplant. 2009 Dec;9(Suppl 4):S116-S130

5. LeFebre ML, U.S. Preventive Services Task Force: Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Jul 1;161(1):58-66. doi:10.7326/M14-1018

6. Jackson K, Locarnini S, Gish R: Diagnostics of hepatitis B virus: Standard of care and investigational. Clin Liver Dis. 2018 Jul;12(1):5-11. doi: 10.1002/cld.729

7. Coffin CS, Zhou K, Terrault NA: New and old biomarkers for diagnosis and management of chronic hepatitis B virus infection. Gastroenterology. 2019 Jan;156(2):355-368. doi: 10.1053/j.gastro.2018.11.037

8. WHO Guidelines Development Group: World Health Organization: Guidelines on hepatitis B and C testing. World Health Organization; 2017. Accessed September 29, 2020. Available at www.who.int/hepatitis/publications/guidelines-hepatitis-c-b-testing/en/

9. Centers for Disease Control and Prevention: Testing and public health management of persons with chronic hepatitis B virus infection. Accessed April 8, 2020. Available at www.cdc.gov/hepatitis/hbv/testingchronic.html

Analytic Time

1 day

Method Name

Chemiluminescent Immunoassay (CIA)

Forms

If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Client Test Request (T728) with the specimen.

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information:

mml-gi-liver-hepatitis