Which patients respond best to hepatitis B vaccination after a hepatitis B virus-related liver transplantation?

Akinobu Takaki, Takahito Yagi, Tetsuya Yasunaka, Hiroshi Sadamori, Susumu Shinoura, Yuzo Umeda, Ryuichi Yoshida, Daisuke Sato, Daisuke Nobuoka, Masashi Utsumi, Yuko Yasuda, Eiichi Nakayama, Yasuhiro Miyake, Fusao Ikeda, Hidenori Shiraha, Kazuhiro Nouso, Toshiyoshi Fujiwara, Kazuhide Yamamoto

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: A combination of hepatitis B immunoglobulin and nucleos(t)ide analogues is the current standard of care for controlling hepatitis B recurrence after orthotopic liver transplantation (OLT). However, frequent immunoglobulin treatment is expensive and inconvenient. This study investigated the efficacy of hepatitis B virus (HBV) vaccination in preventing the recurrence of hepatitis B after living donor OLT. Methods: Twenty-seven patients who had undergone living donor OLT participated in the study; five had acute HBV infected liver failure (ALF-OLT) and 22 had HBV related liver cirrhosis (LC-OLT). Hepatitis B surface antigen (HBsAg)-containing vaccine was administered to them for at least 1 year after transplantation and continued once monthly for up to 36 months post-OLT. Patients who had anti-HBs antibody titers above 100 mIU/mL for a minimum of 6 months without immunoglobulin administration were defined as good responders; the others were defined as poor responders. Interferon-γ enzyme-linked immunospot assays against HBs and HBc antigens were used to assay cellular immune responses. Results: All five of the ALF-OLT patients had good responses after a median of four (range 2.5-5) vaccinations. Nine of the 22 LC-OLT patients had good responses after a median of 19 (range 11.5-30) vaccinations. Among the LC-OLT group, those with livers donated by relatively higher-aged, marital and high-titer anti-HBs antibody donors were good responders. LC-OLT patients classed as good responders showed interferon-γ responses comparable to those of the ALF-OLT patients. Conclusions: The ALF-OLT and LC-OLT patients who received livers from relatively higher-aged, marital, high-titer anti-HBs antibody donors were the best candidates for HBV vaccine administration. Boosting donors before transplantation may facilitate later vaccine response of the recipients.

Original languageEnglish
Pages (from-to)1373-1383
Number of pages11
JournalJournal of Gastroenterology
Volume48
Issue number12
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Hepatitis B
Hepatitis B virus
Liver Transplantation
Vaccination
Immunoglobulins
Anti-Idiotypic Antibodies
Living Donors
Tissue Donors
Interferons
Vaccines
Transplantation
Enzyme-Linked Immunospot Assay
Recurrence
Hepatitis B Vaccines
Liver
Liver Failure
Standard of Care
Hepatitis B Surface Antigens
Cellular Immunity
Liver Cirrhosis

Keywords

  • Hepatitis B immunoglobulin
  • Immune response
  • Living donor liver transplantation
  • Marital donor
  • Vaccination

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Which patients respond best to hepatitis B vaccination after a hepatitis B virus-related liver transplantation? / Takaki, Akinobu; Yagi, Takahito; Yasunaka, Tetsuya; Sadamori, Hiroshi; Shinoura, Susumu; Umeda, Yuzo; Yoshida, Ryuichi; Sato, Daisuke; Nobuoka, Daisuke; Utsumi, Masashi; Yasuda, Yuko; Nakayama, Eiichi; Miyake, Yasuhiro; Ikeda, Fusao; Shiraha, Hidenori; Nouso, Kazuhiro; Fujiwara, Toshiyoshi; Yamamoto, Kazuhide.

In: Journal of Gastroenterology, Vol. 48, No. 12, 12.2013, p. 1373-1383.

Research output: Contribution to journalArticle

Takaki, Akinobu ; Yagi, Takahito ; Yasunaka, Tetsuya ; Sadamori, Hiroshi ; Shinoura, Susumu ; Umeda, Yuzo ; Yoshida, Ryuichi ; Sato, Daisuke ; Nobuoka, Daisuke ; Utsumi, Masashi ; Yasuda, Yuko ; Nakayama, Eiichi ; Miyake, Yasuhiro ; Ikeda, Fusao ; Shiraha, Hidenori ; Nouso, Kazuhiro ; Fujiwara, Toshiyoshi ; Yamamoto, Kazuhide. / Which patients respond best to hepatitis B vaccination after a hepatitis B virus-related liver transplantation?. In: Journal of Gastroenterology. 2013 ; Vol. 48, No. 12. pp. 1373-1383.
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abstract = "Background: A combination of hepatitis B immunoglobulin and nucleos(t)ide analogues is the current standard of care for controlling hepatitis B recurrence after orthotopic liver transplantation (OLT). However, frequent immunoglobulin treatment is expensive and inconvenient. This study investigated the efficacy of hepatitis B virus (HBV) vaccination in preventing the recurrence of hepatitis B after living donor OLT. Methods: Twenty-seven patients who had undergone living donor OLT participated in the study; five had acute HBV infected liver failure (ALF-OLT) and 22 had HBV related liver cirrhosis (LC-OLT). Hepatitis B surface antigen (HBsAg)-containing vaccine was administered to them for at least 1 year after transplantation and continued once monthly for up to 36 months post-OLT. Patients who had anti-HBs antibody titers above 100 mIU/mL for a minimum of 6 months without immunoglobulin administration were defined as good responders; the others were defined as poor responders. Interferon-γ enzyme-linked immunospot assays against HBs and HBc antigens were used to assay cellular immune responses. Results: All five of the ALF-OLT patients had good responses after a median of four (range 2.5-5) vaccinations. Nine of the 22 LC-OLT patients had good responses after a median of 19 (range 11.5-30) vaccinations. Among the LC-OLT group, those with livers donated by relatively higher-aged, marital and high-titer anti-HBs antibody donors were good responders. LC-OLT patients classed as good responders showed interferon-γ responses comparable to those of the ALF-OLT patients. Conclusions: The ALF-OLT and LC-OLT patients who received livers from relatively higher-aged, marital, high-titer anti-HBs antibody donors were the best candidates for HBV vaccine administration. Boosting donors before transplantation may facilitate later vaccine response of the recipients.",
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AU - Takaki, Akinobu

AU - Yagi, Takahito

AU - Yasunaka, Tetsuya

AU - Sadamori, Hiroshi

AU - Shinoura, Susumu

AU - Umeda, Yuzo

AU - Yoshida, Ryuichi

AU - Sato, Daisuke

AU - Nobuoka, Daisuke

AU - Utsumi, Masashi

AU - Yasuda, Yuko

AU - Nakayama, Eiichi

AU - Miyake, Yasuhiro

AU - Ikeda, Fusao

AU - Shiraha, Hidenori

AU - Nouso, Kazuhiro

AU - Fujiwara, Toshiyoshi

AU - Yamamoto, Kazuhide

PY - 2013/12

Y1 - 2013/12

N2 - Background: A combination of hepatitis B immunoglobulin and nucleos(t)ide analogues is the current standard of care for controlling hepatitis B recurrence after orthotopic liver transplantation (OLT). However, frequent immunoglobulin treatment is expensive and inconvenient. This study investigated the efficacy of hepatitis B virus (HBV) vaccination in preventing the recurrence of hepatitis B after living donor OLT. Methods: Twenty-seven patients who had undergone living donor OLT participated in the study; five had acute HBV infected liver failure (ALF-OLT) and 22 had HBV related liver cirrhosis (LC-OLT). Hepatitis B surface antigen (HBsAg)-containing vaccine was administered to them for at least 1 year after transplantation and continued once monthly for up to 36 months post-OLT. Patients who had anti-HBs antibody titers above 100 mIU/mL for a minimum of 6 months without immunoglobulin administration were defined as good responders; the others were defined as poor responders. Interferon-γ enzyme-linked immunospot assays against HBs and HBc antigens were used to assay cellular immune responses. Results: All five of the ALF-OLT patients had good responses after a median of four (range 2.5-5) vaccinations. Nine of the 22 LC-OLT patients had good responses after a median of 19 (range 11.5-30) vaccinations. Among the LC-OLT group, those with livers donated by relatively higher-aged, marital and high-titer anti-HBs antibody donors were good responders. LC-OLT patients classed as good responders showed interferon-γ responses comparable to those of the ALF-OLT patients. Conclusions: The ALF-OLT and LC-OLT patients who received livers from relatively higher-aged, marital, high-titer anti-HBs antibody donors were the best candidates for HBV vaccine administration. Boosting donors before transplantation may facilitate later vaccine response of the recipients.

AB - Background: A combination of hepatitis B immunoglobulin and nucleos(t)ide analogues is the current standard of care for controlling hepatitis B recurrence after orthotopic liver transplantation (OLT). However, frequent immunoglobulin treatment is expensive and inconvenient. This study investigated the efficacy of hepatitis B virus (HBV) vaccination in preventing the recurrence of hepatitis B after living donor OLT. Methods: Twenty-seven patients who had undergone living donor OLT participated in the study; five had acute HBV infected liver failure (ALF-OLT) and 22 had HBV related liver cirrhosis (LC-OLT). Hepatitis B surface antigen (HBsAg)-containing vaccine was administered to them for at least 1 year after transplantation and continued once monthly for up to 36 months post-OLT. Patients who had anti-HBs antibody titers above 100 mIU/mL for a minimum of 6 months without immunoglobulin administration were defined as good responders; the others were defined as poor responders. Interferon-γ enzyme-linked immunospot assays against HBs and HBc antigens were used to assay cellular immune responses. Results: All five of the ALF-OLT patients had good responses after a median of four (range 2.5-5) vaccinations. Nine of the 22 LC-OLT patients had good responses after a median of 19 (range 11.5-30) vaccinations. Among the LC-OLT group, those with livers donated by relatively higher-aged, marital and high-titer anti-HBs antibody donors were good responders. LC-OLT patients classed as good responders showed interferon-γ responses comparable to those of the ALF-OLT patients. Conclusions: The ALF-OLT and LC-OLT patients who received livers from relatively higher-aged, marital, high-titer anti-HBs antibody donors were the best candidates for HBV vaccine administration. Boosting donors before transplantation may facilitate later vaccine response of the recipients.

KW - Hepatitis B immunoglobulin

KW - Immune response

KW - Living donor liver transplantation

KW - Marital donor

KW - Vaccination

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