title: De novo hepatitis b prophylaxis with hepatitis B virus vaccine and hepatitis B immunoglobulin in pediatric recipients of core antibody-positive livers.
abstract: The use of hepatitis B core antibody-positive (HBcAb+) grafts for liver transplantation (LT) has the potential to safely expand the donor pool, as long as proper prophylaxis against de novo hepatitis B (DNHB) is employed. The aim of this study was to characterize the longterm outcome of pediatric LT recipients of HBcAb + liver grafts under a prophylaxis regimen against DNHB using hepatitis B virus (HBV) vaccine and hepatitis B immunoglobulin (HBIG). From June 1996 to February 2013, 49 patients receiving pediatric LT at our center were from HBcAb + donors. Forty-one patients who received DNHB prophylaxis according to our protocol were included in this analysis. Our DNHB prophylaxis protocol consists of HBV vaccine intramuscular injections given intermittently to maintain anti-hepatitis B surface antibody (HBsAb) titers above 100 IU/L. HBIG was also used during the first posttransplant year with a target anti-HBsAb titer level above 200 IU/L. There were 19 boys and 22 girls. Median age was 1.0 year (range, 4 months to 16 years). Median follow-up time was 66 months after transplant. Median annual number of HBV vaccine injections was 0.8 per year (range, 0-1.8 per year). Four patients did not require any HBV vaccine injections during follow-up. One patient with DNHB was encountered during the follow-up period (1/41, 2.4%). DNHB was diagnosed at 3.5 years after transplant, when hepatitis B surface antigen was positive upon routine follow-up serologic testing. Anti-HBsAb titer was 101.5 IU/L at the time. No grafts were lost because of DNHB-related events. Overall survival of the 41 recipients of HBcAb + grafts who received DNHB prophylaxis was 92.3% at 10 years after transplant. In conclusion, longterm prophylaxis against DNHB with HBV vaccine in pediatric LT recipients of HBcAb + grafts was safe and effective in terms of DNHB incidence as well as graft and patient survival.
authors.affiliation: Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Gyu Seong
authors.initials: GS
authors.lastname: Choi
authors.affiliation: Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.affiliation: Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Choon Hyuck David
authors.initials: CH
authors.lastname: Kwon
authors.affiliation: Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Yon-Ho
authors.initials: YH
authors.lastname: Choe
authors.affiliation: Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Joh
authors.affiliation: Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007223:Infant; D007273:Injections, Intramuscular; D019259:Lamivudine / Q000627:therapeutic use; D008099:Liver / Q000821:virology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin