4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

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Guidebook for the Solid Organ Transplant Programme Chapter 4 Appendix H PROTOCOL FOR HEPATITIS B LIVER TRANSPLANT RECIPIENTS Protocol: 1) Lamivudine 100 mg PO daily and 2) HBIG {HBIG is available as: Bay-Hep ® 5ml (1085 units) given IM - must only be given IM (no IV administration) A. Induction phase (Intra-operatively) Bay-Hep ® 10ml (2170IU) IM as 5ml into each deltoid muscle B. HBIG protocol for week 1 to week 52: 1. Post-transplant Week 1 to 6: Bay-Hep ® 10ml (2170IU) IM as 5ml into each gluteal muscle until Hep B titer is > 1000 U/L. Then, Bay-Hep ® 10ML IM (as 5ml into each gluteal/deltoid muscle) Twice weekly (Q Mon, Thurs) for 6 weeks (maintain trough Hep B titer > 500 U/L). 2. Post-transplant weeks 7 to 10: if Hep B titer is > 500 U/L, then give Bay-Hep ® 10ml IM (as 5ml into each gluteal muscle) weekly. 3. Post-transplant weeks 11 to 24: give Bay-Hep ® 10ml every 2 to 4 weeks to maintain Hep B titer > 500 IU/L 4. Post-transplant week 25 to 52: give Bay-Hep ® 10ml every 4 weeks to maintain Hep B titer > 250 IU/L C. HBIG protocol for > 1 year post-transplant: Dose: BaytoHep ® 10ml IM. (as 5ml into each gluteal muscle) Patient to get Hep B AB titer done in the local lab 4 weeks after each injection. The results will be sent to outpatient liver transplant clinic. Then, the frequency of administration of HBIG will be adjusted based on Hep B Ab titer according to the following table Hep B Ab titer (IU/L) Action > 300 Level in 2 weeks 200 to 300 Injection in 3 weeks* 150 to 200 Injection in 2 weeks* 100 to 150 Injection in 1 week* < 100 Injection ASAP* * Please obtain Hep B titer before each injection Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 49 See Page 1 for disclaimer
Guidebook for the Solid Organ Transplant Programme Chapter 4 CMV PROPHYLAXIS AND TREATMENT REGIMENS FOR LIVER TRANSPLANT RECIPIENTS Appendix I CMV STATUS THERAPY DONOR RECIPIENT PROPHYLAXIS PRE-EMPTIVE TREATMENT DISEASE TREATMENT Negative Negative No prophylactic Valganciclovir If CMV PCR > 1000 cp/mL follow treatment protocol CMV PCR testing with bloodwork (maximum q weekly) for 4 months post-transplant and for 2 months following any antiviral treatment. Asymptomatic: Valganciclovir 900 mg PO bid adjusted for renal function for 2 weeks followed by 900 mg PO daily for 4 months. Symptomatic: Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal function x 2 weeks followed by Valganciclovir 900 mg PO daily adjusted for renal function for 4 months. Positive (Mismatch) Negative Ganciclovir 5mg/kg/dose q 12h IV adjusted for renal function x 14 days or until hospital discharge, then Valganciclovir 900 mg PO daily adjusted for renal function until 4 months post transplant. During Lymphocyte Depleting Therapies: Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal function or Valganciclovir 900mg PO daily adjusted for renal function for 2 months. If CMV PCR > 1000 cp/mL and patient is asymptomatic then: Valganciclovir 900 mg PO daily adjusted for renal function until CMV PCR test is < 1000 cp/mL for 2 consecutive weeks and patient is clinically stable (minimum 1 month therapy) Increase Valganciclovir dose to 900 mg PO bid adjusted for renal function if CMV PCR is rising Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal function x 2 weeks followed by Valganciclovir 900 mg PO daily adjusted for renal function for 4 months. If no diarrhea, consider: Valganciclovir 900 mg PO bid adjusted for renal function x 2 weeks followed by Valganciclovir 900 mg PO daily adjusted for renal function for 4 months. Positive OR Negative Positive CMV PCR testing with bloodwork (maximum q weekly) for 6 months post-transplant and for 2 months following any antiviral treatment. No prophylactic Valganciclovir During Lymphocyte Depleting Therapies Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal function or Valganciclovir 900 mg PO daily adjusted for renal function for 2 months. CMV PCR testing with bloodwork (maximum q weekly) for 4 months post-transplant and for 2 months following any antiviral treatment. If CMV PCR > 5000 cp/mL and patient is asymptomatic then: Valganciclovir 900 mg PO daily adjusted for renal function until CMV PCR test is < 2000 cp/mL and decreasing for 2 consecutive weeks and patient is clinically stable (minimum 1 month therapy). Increase Valganciclovir dose to 900 mg PO bid adjusted for renal function if CMV PCR is rising. Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal function x 2 weeks followed by Valganciclovir 900 mg PO daily adjusted for renal function for at least 2 weeks (CMV PCR test should be < 2000 cp/mL and decreasing for 2 consecutive weeks and patient clinically stable prior to discontinuation of Valganciclovir). If no diarrhea, consider: Valganciclovir 900 mg PO bid adjusted for renal function x 2 weeks followed by Valganciclovir 900 mg PO daily adjusted for renal function for at least 2 weeks (CMV PCR test should be < 2000 cp/mL and decreasing for 2 consecutive weeks and patient clinically stable prior to discontinuation of Valganciclovir). Hepatitis C positive recipient (donor or recipient CMV +) Follow mismatch protocol Oral Valganciclovir tablets are supplied free of charge through the BCT Pharmacy Program for outpatients on the above protocol. If total WBC is less than 2.5 x 10 9 /L decrease Valganciclovir dose to 450 mg PO daily. If total WBC is less than 1.5 x 10 9 /L hold Valganciclovir until WBC is greater than 3.5 x 10 9 /L, then restart Valganciclovir at 450 mg PO daily. December 11, 2008 Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 50 See Page 1 for disclaimer
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