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World J Gastroenterol. Oct 21, 2015; 21(39): 11112-11117
Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11112
Active vaccination to prevent de novo hepatitis B virus infection in liver transplantation
Chih-Che Lin, Chee-Chien Yong, Chao-Long Chen
Chih-Che Lin, Chee-Chien Yong, Chao-Long Chen, Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
Author contributions: Lin CC and Yong CC contributed equally to this study; Lin CC partly designed and wrote the paper; Yong CC performed research and wrote the paper; Chen CL supervised the study and revised the paper.
Conflict-of-interest statement: No conflicts of interest were declared for all authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chao-Long Chen, MD, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan. clchen@cgmh.org.tw
Telephone: +886-7-7317123 Fax: +887-7-7324855
Received: April 14, 2015
Peer-review started: April 16, 2015
First decision: May 18, 2015
Revised: June 4, 2015
Accepted: September 13, 2015
Article in press: September 13, 2015
Published online: October 21, 2015
Abstract

The shortage of organ donors mandates the use of liver allograft from anti-HBc(+) donors, especially in areas highly endemic for hepatitis B virus (HBV) infection. The incidence of de novo hepatitis B infection (DNH) is over 30%-70% among recipients of hepatitis B core antibody (HBcAb) (+) grafts without any prophylaxis after liver transplantation (LT). Systematic reviews showed that prophylactic therapy [lamivudine and/or hepatitits B immunoglobulin (HBIG)] dramatically reduces the probability of DNH. However, there are limited studies regarding the effects of active immunization to prevent DNH, and the role of active vaccination is not well-defined. This review focuses on the feasibility and efficacy of pre- and post-LT HBV vaccination to prevent DNH in HBsAg(-) recipient using HBcAb(+) grafts. The presence of HBsAb in combination with lamivudine or HBIG results in lower incidence of DNH and may reduce the requirement of HBIG. There was a trend towards decreasing incidence of DNH with higher titers of HBsAb. High titers of HBsAb (> 1000 IU/L) achieved after repeated vaccination could eliminate the necessity for additional antiviral prophylaxis in pediatric recipients. In summary, active vaccination with adequate HBsAb titer is a feasible, cost-effective strategy to prevent DNH in recipients of HBcAb(+) grafts. HBV vaccination is advised for candidates on waiting list and for recipients after withdrawal of steroids and onset of low dose immunosuppression after transplantation.

Keywords: De novo hepatitis B, Vaccination, Liver transplantation, Core antibody positive donor

Core tip:De novo hepatitis B virus infection (DNH) can both result in significant morbidity and reduced graft survival after liver transplantation. Utilization of hepatitis B core antibody(+) grafts may increase the risk of DNH. Different approaches to mitigate this risk have been described. There is no widespread consensus regarding the prophylactic measures to reduce the incidence of DNH by active immunization. This review examines the important published studies on DNH, and presents the clinically relevant points in a lucid manner. It also presents an algorithm which is simple to follow, and which has been validated in pediatric patients at our center.