Active vaccination to prevent de novo hepatitis B virus infection in liver transplantation.
The shortage of organ donors mandates the use of liver allograft from anti-HBc(+) donors, especially in areas highly endemic for hepatitis B virus (HBV) infection. The incidence of de novo hepatitis B infection (DNH) is over 30%-70% among recipients of hepatitis B core antibody (HBcAb) (+) grafts without any prophylaxis after liver transplantation (LT). Systematic reviews showed that prophylactic therapy [lamivudine and/or hepatitits B immunoglobulin (HBIG)] dramatically reduces the probability of DNH. However, there are limited studies regarding the effects of active immunization to prevent DNH, and the role of active vaccination is not well-defined. This review focuses on the feasibility and efficacy of pre- and post-LT HBV vaccination to prevent DNH in HBsAg(-) recipient using HBcAb(+) grafts. The presence of HBsAb in combination with lamivudine or HBIG results in lower incidence of DNH and may reduce the requirement of HBIG. There was a trend towards decreasing incidence of DNH with higher titers of HBsAb. High titers of HBsAb (> 1000 IU/L) achieved after repeated vaccination could eliminate the necessity for additional antiviral prophylaxis in pediatric recipients. In summary, active vaccination with adequate HBsAb titer is a feasible, cost-effective strategy to prevent DNH in recipients of HBcAb(+) grafts. HBV vaccination is advised for candidates on waiting list and for recipients after withdrawal of steroids and onset of low dose immunosuppression after transplantation.
Chih-Che Lin, Chee-Chien Yong, Chao-Long Chen, Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Chih-Che
CC
Lin
Chih-Che Lin, Chee-Chien Yong, Chao-Long Chen, Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Chee-Chien
CC
Yong
Chih-Che Lin, Chee-Chien Yong, Chao-Long Chen, Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Chao-Long
CL
Chen
D000998:Antiviral Agents / Q000008:administration & dosage; D046148:Donor Selection; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019259:Lamivudine / Q000008:administration & dosage; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014611:Vaccination; D014850:Waiting Lists
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin
Core antibody positive donor; De novo hepatitis B; Liver transplantation; Vaccination