title: High-titer antibody to hepatitis B surface antigen before liver transplantation can prevent de novo hepatitis B infection.
abstract: OBJECTIVE
  De novo hepatitis B virus (HBV) infection is defined as infection occurring in HBV surface antigen (HBsAg)-negative patients who become HbsAg positive after organ transplantation. We assessed the incidence and risk factors of de novo HBV infection in pediatric liver transplant recipients.
  
  
  METHODS
  From 1996 to 2006, 71 Taiwanese children with non-HBV-related liver diseases underwent orthotopic liver transplantation (OLT) at the National Taiwan University Hospital. All of the surviving recipients were tested regularly for liver function, serum levels of immunosuppressant, HBsAg, titers of antibodies to hepatitis B surface antigen (anti-HBs), antibodies to hepatitis B core antigen (anti-HBc), and antibodies to hepatitis C virus (anti-HCV). HBV vaccination histories and the anti-HBs titers before OLT were recorded. No regular prophylaxis was given.
  
  
  RESULTS
  Fifty-nine patients (33 girls and 26 boys) were followed up for a median of 4.4 years (range 1.0-10.0). Of those, 36 (61.0%) received allografts from anti-HBc-positive and HBsAg-negative donors. De novo HBV infection was found in 9 (15.3%) patients after OLT, 8 of whom received allografts from HBsAg-negative and anti-HBc-positive donors. Forty-eight (81.4%) patients received 3 or more doses of HBV vaccine before OLT. Pre-OLT anti-HBs titers were available for 49 recipients. Of the 9 de novo HBV-infected recipients, 8 had anti-HBs titers <200 mIU/mL. No graft loss or fulminant hepatitis was noted.
  
  
  CONCLUSIONS
  In the absence of adequate prophylaxis, the incidence of de novo HBV infection in pediatric OLT recipients is 15.3%. An anti-HBs titer of >200 mIU/mL before OLT may be sufficient to prevent de novo HBV infection in HBsAg-negative recipients.
authors.affiliation: Department of Pediatrics, College of Medicine and Hospital, National Taiwan University, Taipei.
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Su
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Ho
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
authors.forename: Yao-Ming
authors.initials: YM
authors.lastname: Wu
authors.forename: Mei-Hwei
authors.initials: MH
authors.lastname: Chang
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000097:blood / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood* / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D015994:Incidence; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines