Long-term efficacy of hepatitis B vaccination as post-transplant prophylaxis in hepatitis B surface antigen (HBsAg) positive recipients and HBsAg negative recipients of anti-hepatitis B core positive grafts

Atsushi Yoshizawa; Noriyo Yamashiki; Yoshihide Ueda; Toshimi Kaido; Hideaki Okajima; Hiroyuki Marusawa; Tsutomu Chiba; Shinji Uemoto

doi:10.1111/hepr.12586

Long-term efficacy of hepatitis B vaccination as post-transplant prophylaxis in hepatitis B surface antigen (HBsAg) positive recipients and HBsAg negative recipients of anti-hepatitis B core positive grafts

Hepatol Res. 2016 May;46(6):541-51. doi: 10.1111/hepr.12586. Epub 2015 Oct 8.

Authors

Atsushi Yoshizawa¹, Noriyo Yamashiki², Yoshihide Ueda^{2

3}, Toshimi Kaido^{1

2}, Hideaki Okajima¹, Hiroyuki Marusawa³, Tsutomu Chiba³, Shinji Uemoto^{1

2}

Affiliations

¹ Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Organ Transplantation Unit, Kyoto University, Kyoto, Japan.
³ Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

PMID: 26348993
DOI: 10.1111/hepr.12586

Abstract

Aim: Hepatitis B virus (HBV) reactivation after liver transplantation in HBV patients, or in HBV negative recipients of anti-hepatitis B core (HBc) positive grafts, has been prevented by prophylactic use of hepatitis B immunoglobulin (HBIG) and/or nucleoside/nucleotide analogs (NA). Vaccination against HBV is an alternative that may provide a chance to discontinue prophylaxis by producing anti-hepatitis B surface (HBs) antibodies.

Methods: We retrospectively reviewed 40 HBV positive recipients (HBV+ group) and 27 HBV negative recipients of anti-HBc positive grafts (HBV-/anti-HBc+ graft group), who were administrated double-dose hepatitis B vaccination. Recipients were regarded as responders when anti-HBs greater than 100 IU/L was maintained for 6 months or more without HBIG. Response rates of vaccine and long-term outcomes were analyzed.

Results: Eighteen of the 40 patients in the HBV+ group (45%) and 18 of the 27 patients in the HBV-/anti-HBc+ graft group (67%) responded to vaccination after a median of four and three times, respectively. Younger age was the only independent factor associated with vaccine response in the HBV-/anti-HBc+ graft group (P = 0.03), whereas no factor was found to be an independent predictor for vaccine response in the HBV+ group. Among the 18 responders in the HBV+ group, 17 remained without NA or HBIG 8.2 years after the start of vaccination. Ten of those required periodic booster vaccination. All 18 responders in the HBV-/anti-HBc+ graft group remained free from HBV prophylaxis 6.2 years after the start of vaccination.

Conclusion: Younger recipients have a greater chance to develop sufficient anti-HBs after double-dose HBV vaccination, leading to discontinue HBV prophylaxis.

Keywords: antibody to hepatitis B core antigen; antiviral agents; hepatitis B hyperimmunoglobulin.