Journal Article

Which patients respond best to hepatitis B vaccination after a hepatitis B virus-related liver transplantation?

Nobuoka, Daisuke, Nouso, Kazuhiro, Yoshida, Ryuichi, Umeda, Yuzo, Yasunaka, Tetsuya, Shinoura, Susumu, Nakayama, Eiichi, Fujiwara, Toshiyoshi, Shiraha, Hidenori, Yamamoto, Kazuhide, Yagi, Takahito, Sadamori, Hiroshi, Sato, Daisuke, Utsumi, Masashi, Yasuda, Yuko, Ikeda, Fusao, Miyake, Yasuhiro, Takaki, Akinobu

2013

Overview

Background A combination of hepatitis B immunoglobulin and nucleos(t)ide analogues is the current standard of care for controlling hepatitis B recurrence after orthotopic liver transplantation (OLT). However, frequent immunoglobulin treatment is expensive and inconvenient. This study investigated the efficacy of hepatitis B virus (HBV) vaccination in preventing the recurrence of hepatitis B after living donor OLT. Methods Twenty-seven patients who had undergone living donor OLT participated in the study; five had acute HBV infected liver failure (ALF-OLT) and 22 had HBV related liver cirrhosis (LC-OLT). Hepatitis B surface antigen (HBsAg)-containing vaccine was administered to them for at least 1 year after transplantation and continued once monthly for up to 36 months post-OLT. Patients who had anti-HBs antibody titers above 100 mIU/mL for a minimum of 6 months without immunoglobulin administration were defined as good responders; the others were defined as poor responders. Interferon-γ enzyme-linked immunospot assays against HBs and HBc antigens were used to assay cellular immune responses. Results All five of the ALF-OLT patients had good responses after a median of four (range 2.5–5) vaccinations. Nine of the 22 LC-OLT patients had good responses after a median of 19 (range 11.5–30) vaccinations. Among the LC-OLT group, those with livers donated by relatively higher-aged, marital and high-titer anti-HBs antibody donors were good responders. LC-OLT patients classed as good responders showed interferon-γ responses comparable to those of the ALF-OLT patients. Conclusions The ALF-OLT and LC-OLT patients who received livers from relatively higher-aged, marital, high-titer anti-HBs antibody donors were the best candidates for HBV vaccine administration. Boosting donors before transplantation may facilitate later vaccine response of the recipients.

• Publisher: Springer Japan,Springer,Springer Nature B.V
• Subject: Abdominal Surgery / Adult / Antigens / Biliary Tract / Biological response modifiers / Cirrhosis / Colorectal Surgery / Control / Donation of organs, tissues, etc / Enzyme-Linked Immunospot Assay - methods / Enzymes / Female / Follow-Up Studies / Gastroenterology / Hepatitis B / Hepatitis B - complications / Hepatitis B - prevention & control / Hepatitis B Antibodies - immunology / Hepatitis B Surface Antigens - immunology / Hepatitis B vaccine / Hepatitis B Vaccines - administration & dosage / Hepatitis B Vaccines - immunology / Hepatitis B virus / Hepatology / Humans / Immunoglobulins - immunology / Interferon / Interferon-gamma - immunology / Liver / Liver cirrhosis / Liver Cirrhosis - surgery / Liver Cirrhosis - virology / Liver Failure, Acute - surgery / Liver Failure, Acute - virology / Liver Transplantation / Living Donors / Male / Medicine / Medicine & Public Health / Middle Aged / Original Article—Liver / Original —Liver, Pancreas, and Biliary Tract / Pancreas / Patient Selection / Prevention / Secondary Prevention / Surgical Oncology / Transplantation / Vaccination