Successful hepatitis B vaccination in liver transplant recipients with donor-specific hyporesponsiveness.
Currently, patients are prescribed lifelong treatment with hepatitis B immunoglobulin (HBIg) after liver transplantation (LT) for hepatitis B virus (HBV)-related diseases in order to prevent reinfection with HBV. Active immunization with an HBV vaccine would be a preferable alternative; however, the immunosuppressive environment in LT recipients is believed to elicit a poor response to vaccination. Minimizing the exposure of the HBV-infected LT recipients to immunosuppressants would be beneficial in inducing adaptive immunity against HBV by vaccination. In this study, in addition to efforts to minimize immunosuppression, prophylaxis with HBV vaccination combined with continuous HBIg administration was performed in 17 LT recipients who had undergone transplantation attributable to HBV-related diseases. During the observation period, the overall response rate to HBV vaccination was 64.7%. The immune status of the recipients was evaluated by a mixed lymphocyte reaction assay in response to allostimulation. Patients showing a donor-specific hyporesponse with a well-maintained response to the third-party stimulus always achieved a sustained immune response to the vaccine, whereas patients showing a hyporesponse to both the donor and the third-party stimulus were unable to do so. Thus, inducing an anti-donor-specific immunosuppressive status by minimizing immunosuppression should enable post-transplant HBV vaccination to be a promising prophylactic strategy.
Tahara
Hiroyuki
H
Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
Tanaka
Yuka
Y
Ishiyama
Kohei
K
Ide
Kentaro
K
Shishida
Masayuki
M
Irei
Toshimitsu
T
Ushitora
Yuichiro
Y
Ohira
Masahiro
M
Banshodani
Masataka
M
Tashiro
Hirotaka
H
Itamoto
Toshiyuki
T
Asahara
Toshimasa
T
Imamura
Michio
M
Takahashi
Shoichi
S
Chayama
Kazuaki
K
Ohdan
Hideki
H
D000328:Adult; D000368:Aged; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006801:Humans; D007116:Immunization, Passive; D007117:Immunization, Secondary; D007136:Immunoglobulins / Q000627:therapeutic use; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D014611:Vaccination
D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin