title: Which patients respond best to hepatitis B vaccination after a hepatitis B virus-related liver transplantation?
abstract: 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.
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan, akitaka@md.okayama-u.ac.jp.
authors: Akinobu
authors: A
authors: Takaki
authors: Takahito
authors: T
authors: Yagi
authors: Tetsuya
authors: T
authors: Yasunaka
authors: Hiroshi
authors: H
authors: Sadamori
authors: Susumu
authors: S
authors: Shinoura
authors: Yuzo
authors: Y
authors: Umeda
authors: Ryuichi
authors: R
authors: Yoshida
authors: Daisuke
authors: D
authors: Sato
authors: Daisuke
authors: D
authors: Nobuoka
authors: Masashi
authors: M
authors: Utsumi
authors: Yuko
authors: Y
authors: Yasuda
authors: Eiichi
authors: E
authors: Nakayama
authors: Yasuhiro
authors: Y
authors: Miyake
authors: Fusao
authors: F
authors: Ikeda
authors: Hidenori
authors: H
authors: Shiraha
authors: Kazuhiro
authors: K
authors: Nouso
authors: Toshiyoshi
authors: T
authors: Fujiwara
authors: Kazuhide
authors: K
authors: Yamamoto
mesh_terms: D000328:Adult; D058501:Enzyme-Linked Immunospot Assay / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology; D007371:Interferon-gamma / Q000276:immunology; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D017114:Liver Failure, Acute / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055502:Secondary Prevention
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; D007371:Interferon-gamma; C045213:hepatitis B hyperimmune globulin