Long-term efficacy of hepatitis B vaccination as post-transplant prophylaxis in hepatitis B surface antigen (HBsAg) positive recipients and HBsAg negative recipients of anti-hepatitis B core positive grafts

• Published in: Hepatology research 2016-05, Vol.46 (6), p.541-551
• Main Authors: Yoshizawa, Atsushi, Yamashiki, Noriyo, Ueda, Yoshihide, Kaido, Toshimi, Okajima, Hideaki, Marusawa, Hiroyuki, Chiba, Tsutomu, Uemoto, Shinji
• Format: Article
• Language: English
• Subjects: antibody to hepatitis B core antigen; antiviral agents; hepatitis B hyperimmunoglobulin
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.12586

Aim Hepatitis B virus (HBV) reactivation after liver transplantation in HBV patients, or in HBV negative recipients of anti‐hepatitis B core (HBc) positive grafts, has been prevented by prophylactic use of hepatitis B immunoglobulin (HBIG) and/or nucleoside/nucleotide analogs (NA). Vaccination against HBV is an alternative that may provide a chance to discontinue prophylaxis by producing anti‐hepatitis B surface (HBs) antibodies. Methods We retrospectively reviewed 40 HBV positive recipients (HBV+ group) and 27 HBV negative recipients of anti‐HBc positive grafts (HBV−/anti‐HBc+ graft group), who were administrated double‐dose hepatitis B vaccination. Recipients were regarded as responders when anti‐HBs greater than 100 IU/L was maintained for 6 months or more without HBIG. Response rates of vaccine and long‐term outcomes were analyzed. Results Eighteen of the 40 patients in the HBV+ group (45%) and 18 of the 27 patients in the HBV−/anti‐HBc+ graft group (67%) responded to vaccination after a median of four and three times, respectively. Younger age was the only independent factor associated with vaccine response in the HBV−/anti‐HBc+ graft group (P = 0.03), whereas no factor was found to be an independent predictor for vaccine response in the HBV+ group. Among the 18 responders in the HBV+ group, 17 remained without NA or HBIG 8.2 years after the start of vaccination. Ten of those required periodic booster vaccination. All 18 responders in the HBV−/anti‐HBc+ graft group remained free from HBV prophylaxis 6.2 years after the start of vaccination. Conclusion Younger recipients have a greater chance to develop sufficient anti‐HBs after double‐dose HBV vaccination, leading to discontinue HBV prophylaxis.