Discontinuation of Hepatitis B Immunoglobulin by Long-term Hepatitis B Vaccine Inoculation in Preventing Hepatitis B Recurrence After Liver Transplantation.
BACKGROUND
For the patients undergoing liver transplantation for hepatitis B virus (HBV)-related diseases, hepatitis B immunoglobulin (HBIG) should be administered to prevent reinfection. Because HBIG is highly expensive and a blood product, an alternative strategy using HBV vaccination has been made in an attempt to discontinue use of HBIG. The aim of this study was to evaluate the impact of long-term HBV vaccination for discontinuation of HBIG, paying attention to the status of active immunization using T-cell proliferation assay.


METHODS
Among the 144 recipients who underwent liver transplantation in our hospital, 16 had HBV-related liver diseases; the 14 patients who had received vaccination were subjects in our study. To evaluate the status of active immunization, T-cell proliferation was examined by counting the number of T cells after adding HBV vaccine to the culture supernatant of T cells, and tumor necrosis factor α and interferon γ were measured in the culture supernatant.


RESULTS
The ratio of male/female was 13/1 (median age: 55 years; range: 37 years to 67 years). The median follow-up time was 102 months (range: approximately 14 months to 148 months). All 14 patients were free of HBV recurrence. HBIG-free status could be achieved in 9 patients (64.3%) during the treatment period for more than 50 months after beginning of HBV vaccination, of whom 5 (35.7%) became HBV vaccine-free. T-cell proliferation was confirmed by fact that the stimulation index ranged from 2.34 to 5.2 in the patients who were HBIG-free.


CONCLUSIONS
Long-term HBV vaccination after LT is a useful and effective treatment in preventing HBV recurrence, allowing the discontinuation of HBIG treatment.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan. Electronic address: m-usui@clin.medic.mie-u.ac.jp.
M
M
Usui
Hepatogastroenterology, Mie Graduate School of Medicine, Tsu, Mie, Japan.
K
K
Sugimoto
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
H
H
Kato
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
Y
Y
Murata
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
A
A
Tanemura
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
N
N
Kuriyama
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
Y
Y
Azumi
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
M
M
Kishiwada
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
S
S
Mizuno
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
H
H
Sakurai
Hepatogastroenterology, Mie Graduate School of Medicine, Tsu, Mie, Japan.
Y
Y
Takei
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie Graduate School of Medicine, Tsu, Mie, Japan.
S
S
Isaji
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D017114:Liver Failure, Acute / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention; D013601:T-Lymphocytes; D018417:Th1 Cells; D016896:Treatment Outcome; D014611:Vaccination
D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin