Successful active immunization using a hepatitis B virus vaccination protocol for a recipient with hepatitis B core antibody-positive liver graft.
BACKGROUND
Donor shortages occasionally necessitate the use of hepatic allografts from hepatitis B core antibody-positive (HBcAb+) donors, with an attendant risk of post-transplantation hepatitis B virus (HBV) infection. The aim of the present study was to develop and evaluate a protocol of active immunization for prevention of post-transplantation de novo HBV infection in patients receiving liver grafts from HBcAb+ donors.


METHODS
Ten patients who had received HBcAb+ liver grafts at Shinshu University Hospital between October 1996 and December 2012 were enrolled. All the recipients were negative for HBV serological tests, and HBV-DNA. Hepatitis B immunoglobulin (HBIG) was given routinely in the peritransplantation and post-transplantation periods, without antiviral drugs. Subcutaneous vaccination with recombinant HBV was given at a dosage of 20 μg in adults and 5 μg in children concomitant with HBIG until acquisition of active immunization. The timing to start HBV vaccination was dependent on the condition of the patient.


RESULTS
The median follow-up period after liver transplantation was 140 months, and the median period after transplantation until the start of vaccination was 7.0 months. Nine patients (90%) acquired active immunity after a median number of 4 (range, 2-13) vaccinations (hepatitis B surface antibody >300 mIU/mL for 1 year, or >100 mIU/mL thereafter), and did not require HBIG administration thereafter. None had any side effects of HBV vaccination or developed hepatitis B infection during the study period. Four fast responders who achieved antibody high titers by active immunization within 9 months received pretransplantation vaccinations, whereas 5 slow responders did not.


CONCLUSIONS
Our vaccination protocol provides a new effective strategy for prevention of de novo hepatitis B infection after liver transplantation in recipients with HBcAb+ liver grafts. Pretransplantation HBV vaccination was helpful for the post-transplantation vaccine response.
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Y
Y
Ohno
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: mita@shinshu-u.ac.jp.
A
A
Mita
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
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T
Ikegami
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Y
Y
Masuda
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
K
K
Urata
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Y
Y
Nakazawa
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
A
A
Kobayashi
Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
S
S
Miyagawa
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D017325:Hepatitis B Vaccines; D007166:Immunosuppressive Agents