Search

Prophylaxis with hepatitis B immunoglobulin (HBIG) and nucleoside analogs can prevent hepatitis B virus (HBV) recurrence after liver transplant (LT).To determine the efficacy and cost of maintaining immunoprophylaxis with HBIG and hyperimmune plasma (HIP) for 6 months after LT.The study included 22 HBV related LT recipients who were on entecavir and either HBIG or HIP for 6 months. Post transplant HBIG or HIP dose and cost incurred towards prophylaxis were noted. The cost of 200 IU of HBIG at the time of study was Rs 8250/- (US Dollars 135) and that of 2000 IU of HIP was Rs 8000/- (USD 130.7). The loading and maintenance costs at end of 6 months were compared between the two groups. Response to HBIG and HIP was assessed by checking for HBsAg reactivity, anti HBs titer response and HBV DNA viral load.Median and range, Kruskal Wallis (KW) sign rank Sum Test and Correlation Coefficient (r2) was used for analysis.Thirteen recipients received HBIG and 9 recipients HIP. The anti HBs response to HIP was significantly high compared to HBIG (KW Sign rank Sum test P 0.05); titers remained high until the study period. Between 8 and 30 days, the titer achieved by both HBIG and HIP was similar (KW Sign rank Sum test not significant). Despite low anti HBs titer of100 IU/L, none of the recipients on HBIG had HBsAg reactivity while 3 on HIP had transient HBsAg positivity. The total cost with HBIG was 13.9 times the cost of HIP.HIP immunoprophylaxis in combination with entecavir achieves a high anti HBs titer at a significant low cost during anhepatic and loading phase. HBV reactivation rates with HBIG and HIP is low despite low anti HBs titer.

Liver transplantation for end-stage liver disease is increasingly being undertaken in India.(1) Routine tuberculin skin testing (TST) for latent Mycobacterium tuberculosis infection (LTBI) and isoniazid prophylaxis in TST-positive liver-transplant recipients (LTRs) is recommended(2,3) but seldom implemented worldwide.(4-7) The role of TST-testing and isoniazid prophylaxis in LTRs remains further undefined in high prevalence areas, including India. We describe the burden of LTBI in LTRs; the epidemiological aspects of M. tuberculosis infection in high prevalence areas; identifiable risk factors for M. tuberculosis infection; the limitations of current diagnostic techniques for LTBI in LTRs and the efficacy and toxicity of isoniazid prophylaxis in TST-positive LTRs and suggest directions for future investigations in this area.

Auxiliary liver transplantation is an accepted form of therapy in acute liver failure and in certain metabolic disorders. We report India's first successful auxiliary liver transplantation for Crigler-Najjar syndrome type 1, showing that it is technically feasible and safe procedure. It is utmost important to select appropriate cases for auxiliary transplant for successful long-term outcome. The surgeon should also have an understanding of the portal flow dynamics, as steal phenomenon can occur, depriving blood blow to either graft or native liver. Though successful in animal models, gene therapy is still in experimental stage in humans and pace of progress has been disappointing. Auxiliary liver transplantation retains the native liver for future gene therapy. These children are young and are likely to have a long life expectancy, and withdrawal of immunosuppression would be a huge advantage.

Puducherry (Formerly Pondicherry) is a union territory in South India. On the occasion of world hepatitis day 2013 we had conducted a free Hepatitis B and C screening camp for the general public of Puducherry. The purpose of the camp was to create awareness and diagnose hepatitis B and C among the general public. Prevalence data of Hepatitis B and C from Puducherry is not available. The screening camp was a daylong event starting at 10 am and finishing at 10 pm on the 28th of July 2013 on world hepatitis day. This was conducted in 4 locations (Beach road, Muthialpet, Villianour and Ouruvaiyar) across Puducherry. Newspaper adverts, televisions scrolling in local channels and pamphlets distribution were done prior to the screening camp to inform public regarding the event. Hepatitis B detection was done using the “INSTACHK”, a rapid HbsAg kit marketed by Trans-asia biomedicals limited. It is a colloid gold enhanced immunoassay for the detection of HBsAg in human whole blood, serum or plasma. It is a qualitative test, which according to the manufacturer's guideline has a sensitivity and specificity of around 98% along with a positive predictive value of 98%. Hepatitis C virus (HCV) screening was done using the “INSTACHK”, a rapid HCV test which is a colloid gold enhanced one step immunochromatographic assay for the qualitative detection of antibodies to hepatitis C viruses in whole blood, serum or plasma. It is a 3rd generation anti HCV assay, which utilizes core NS3, NS4, NS5 regions of the HCV genome and has a sensitivity and specificity of 100% according to manufacturer's guideline. We used one drop of blood obtained after a lancet prick which was sucked up using a plastic pipette and dropped into the test well of the test card immediately. The results were interpreted after 15 minutes. A total of 978 people were screened across 4 centers. There were 691 males to 287 females (70.6:29.3). The youngest to get screened was 3 and the oldest was 82 years. The mean age was 39.7 years. Twenty-nine people tested positive for HBsAg and two for anti-HCV. The Point prevalence of HbsAg and HCV were 2.96 and 0.20% from this study. The mean age of the HBsAg positive patients was 41.5 and the age range was 26–61 years. The HBsAg positive patients were predominantly male (24:5). The two patients who were tested positive for anti-HCV were males aged 23 and 54 years. The patients who were tested positive were subsequently followed up in the clinic. 23 patients with HBsAg positivity and one with HCV attended the clinic. 13 patients with HBV and the one HCV patient are undergoing treatment at present. The total population of Puducherry as per 2011 census is 9, 50,289 with a sex ratio of 970 females to 1000 males. The density of population is 3232 people per square kilometer. The average literacy rate is 85.4% with an urban, rural population of 69.1 and 30.8% respectively.1 Prevalence of hepatitis B in India is classified as intermediate (2–7%) as per World Health Organization. Recent meta-analysis reveals that the prevalence of Hepatitis B in tribal and non-tribal populations of India varies significantly and is 11.85% and 3.07% respectively with an overall country prevalence of 3.7%.2 Prevalence of anti-HCV positivity in India is around 1% and varies between 0.09 to 7.89%.3 There have been numerous studies in India reporting hepatitis B prevalence and some of them have been noted as community based. The study by Ahmad et al was a hospital based study from Chandigarh using blood samples from “apparently healthy individuals”. The HBsAg prevalence in this group was reported as 2.4%.4 Bhagyalaxmi et al conducted a “house to house survey and selected the youngest patient in the family” for HBV testing and reported a prevalence of 1.43%.5 Kaur et al reported an HBsAg prevalence of 2.9% among the “student population” in Chandigarh.6 Kurien et al from Christian Medical College, Vellore tested for hepatitis B in “stored samples of blood” from a representative population of Tamil Nadu used for an earlier survey on sexually transmitted diseases and reported prevalence of HBsAg as 2.1%.7 Singh et al reported prevalence of 3.3% in Bangalore and 4.2% in Rajmundry based on the study where 10–20 households were “randomly selected” from each locality in these two cities and only the “youngest apparently healthy individual” from each house were tested.8 The locations were specifically chosen to represent both the urban and rural areas of Puducherry. Beach road and Muthialpet represented urban Puducherry while Villianour and Ouruvaiyar represented the rural area. The beach road location was chosen as people of all age, social class and status visit the beach throughout the day on Sundays and hence screening here would represent the population of Puducherry. We do get foreign and other state tourists visiting the beach but none of them got screened in this event. The diagnostic kits (INSTACHK) used for this camp is not the standard immunoassays that depend on colorimetric or chemi-luminescence signal measurement but this has got sufficient sensitivity and specificity almost comparable to the standard tests as per the manufacturer's guideline although there is no literature to support its use. Previous community based studies in India have also used finger prick test.5,8