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

• Published in: Journal of gastroenterology 2013-12, Vol.48 (12), p.1373-1383
• Main Authors: Takaki, Akinobu, Yagi, Takahito, Yasunaka, Tetsuya, Sadamori, Hiroshi, Shinoura, Susumu, Umeda, Yuzo, Yoshida, Ryuichi, Sato, Daisuke, Nobuoka, Daisuke, Utsumi, Masashi, Yasuda, Yuko, Nakayama, Eiichi, Miyake, Yasuhiro, Ikeda, Fusao, Shiraha, Hidenori, Nouso, Kazuhiro, Fujiwara, Toshiyoshi, Yamamoto, Kazuhide
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-013-0763-8

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.