A considerable proportion of
liver transplantation recipients who receive
hepatitis B immunoglobulin (
HBIG) monotherapy for hepatitis B virus (HBV) prophylaxis develop resistance to
HBIG. We retrospectively assessed the efficacy of HBV prophylaxis in 1524 patients who received primary high-dose
HBIG monotherapy (n = 1463) or with a preemptive
antiviral add-on as secondary combination
therapy (n = 61). At a median follow-up time of 57 months, 106 (7.3%) patients receiving
HBIG monotherapy experienced HBV recurrence, with a 10-year HBV recurrence rate of 9.8%, compared to none of the patients receiving preemptive combination
therapy (P = 0.047). Thirteen patients (12.3%) with HBV recurrence failed
antiviral therapy, leading to death or retransplantation. Response rates to rescue
therapy before and after use of
adefovir/
entecavir were 44.4% and 91.8%, respectively. Acute exacerbation was not associated with treatment failure, but required prolonged treatment. Of 84 surviving patients with HBV recurrence, 44 (52.4%) showed no evidence of blood HBV
DNA. The Gly145Arg mutation was found in 11 of 15 (73.3%) patients, whereas 25 of 71 (35.2%), 2 of 29 (6.9%), and 4 of 8 (50%) patients were resistant to
lamivudine,
adefovir, and
entecavir, respectively. In conclusion, our finding of a 10-year HBV recurrence rate of 9.8% in patients receiving high-dose
HBIG monotherapy indicates that this treatment is effective but requires complementary measures. Strict surveillance following
HBIG monotherapy is necessary to enhance responses to rescue
antiviral therapy. Preemptive conversion to combination
therapy has a complementary role in prophylaxis with primary high-dose
HBIG monotherapy, especially for patients at high risk of HBV recurrence.