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Source: Liver Transpl | Posted 1 day agoActive Immunization for Prevention of De Novo HBV infection after Adult Living Donor Liver Transplantation with HBc(+) Graft; Wang S, Loh P, Lin T, Lin L, Lee W, Lin Y, Lin C, Chen C; Liver Transplantation (Jul 2017)
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Background De novo hepatitis B infection (DNHB) may occur in recipients who do not receive prophylaxis after liver transplantation (LT) with anti-HBc(+) donor grafts. Active immunization has been shown to prevent DNHB in pediatric recipients. Our aim is to investigate the efficacy of HBV vaccination for preventing DNHB in adult living donor LT (LDLT). Patients and Methods 71 adult HBsAg(-) LDLT patients who received anti-HBc(+) grafts from 2000 to 2010 were enrolled into this study. Patients were given HBV vaccinations with the aim of achieving anti-HBs>1000 IU/L pre-transplant and>100 IU/L post-transplant. The cohort was stratified into 3 groups: patients with pre-transplant anti-HBs titer>1000 IU/L without need for post-transplant prophylaxis (group 1, n=24), patients with pre-transplant low titer<1000 IU/L who were given post-transplant lamivudine prophylaxis and responded appropriately to post-transplant vaccination by maintaining anti-HBs titers>100 IU/L (group 2, n=30), and low titer nonresponders (anti-HBs titer<100 IU/L despite vaccination), for whom lamivudine was continued indefinitely (group 3, n=17). Results All DNHB occurred in group 3 patients with posttransplant anti-HBs levels<100 IU/L, with an incidence rate of 17.6% compared to 0% in patients with posttransplant anti-HBs>100 IU/L (p=0.001). Pre-transplant anti-HBs level of>1000 IU/L was significantly associated with early attainment and sustained level of posttransplant anti-HBs of>100 IU/L (p<0.001). Conclusion Active immunization is effective in preventing DNHB in adult LDLT if the post-transplant anti-HBs level is maintained above 100 IU/L with vaccination. Anti-viral prophylaxis can be safely discontinued in patients who obtain this immunity. This article is protected by copyright. All rights reserved.
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发表于 2017-7-26 18:08
