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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 levels during intravenous or intramuscular hepatitis B immune globulin therapy to prevent hepatitis B virus (HBV) reinfection in liver transplant recipients with known previous chronic HBV

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 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

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

Report Available

Same day/1 to 3 days

Day(s) Performed

Monday through Saturday

Clinical Reference

1. Samuel D: Management of hepatitis B in liver transplant patients. Semin Liver Dis. 2004;24 Suppl 1:55-62. doi: 10.1055/s-2004-828679

2. Terrault NA, Vyas G: Hepatitis B immune globulin preparations and use in liver transplantation. Clin Liver Dis. 2003 Aug;7(3):537-550. doi: 10.1016/s1089-3261(03)00045-x

3. Lok AS: Prevention of recurrent hepatitis B post-liver transplantation. Liver Transpl. 2002 Oct;8:S67-S73. doi: 10.1053/jlts.2002.35780

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. doi: 10.1111/j.1600-6143.2009.02902.x

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 Aug;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. World Health Organization: WHO guidelines on hepatitis B and C testing. 2017. Accessed September 29, 2020. Available at: www.who.int/hepatitis/publications/HEP17001_WEB11.pdf?ua=1

9. Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention: Testing and public health management of persons with chronic hepatitis B virus infection. Centers for Disease Control and Prevention. Updated October 8, 2019. Accessed April 8, 2020. Available at www.cdc.gov/hepatitis/hbv/testingchronic.htm

Method Name

Chemiluminescent Immunoassay (CIA)

Specimen Type

Serum SST


Ordering Guidance


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

Test Classification

This test has been cleared, approved, or is exempt by the US 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 5193-8

 

Result ID Test Result Name Result LOINC Value
HBABT HBs Ab Monitor, Post-transplant, S 5193-8

Forms

If not ordering electronically, complete, print, and send 1 of the following:

-Gastroenterology and Hepatology Client Test Request (T728)

-Infectious Disease Serology Test Request (T916)

Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog Additional Information:

mml-hepatitis