Hepatitis B vaccination after liver transplantation as a strategy to discontinue prophylaxis with hepatitis B immune globulin

Rimola, Antoni; Sánchez‐Fueyo, Alberto

doi:10.1016/j.jhep.2004.02.014

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…Some studies have demonstrated that HBIg discontinuation with maintenance oral anti-viral monotherapy was safe and effective for HBV liver transplant recipients. 21,22 In the present study, 11 recipients retained detectable HBV total and ccc DNA levels even though the standard prophylactic strategy after LT was followed, and those recipients should be considered at high risk of HBV reinfection. For those recipients, it might be necessary to administer long-term therapy of HBIG in combination with antiviral agents.…”

Section: Discussionmentioning

confidence: 71%

“…[8][9][10][11] Active immunization with standard hepatitis B vaccines in these patients is considered a promising substitute to the current treatment strategy, although the results of this new strategy have been controversial. [12][13][14][15][16][17][18][19][20][21][22] Some studies have reported that responders to hepatitis B vaccination, defined as patients with anti-HBs, should stop taking HBIG and/or antiviral agents. 12,16,17,[20][21][22] However, the safety of discontinuing HBIG and/or antiviral agents in responders remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18][19][20][21][22] Some studies have reported that responders to hepatitis B vaccination, defined as patients with anti-HBs, should stop taking HBIG and/or antiviral agents. 12,16,17,[20][21][22] However, the safety of discontinuing HBIG and/or antiviral agents in responders remains unclear. In the present study, we investigated intrahepatic and extrahepatic HBV total DNA and ccc DNA in responders to active hepatitis B immune reconstitution who had discontinued HBIG and/or antiviral agents and in non-responders to active hepatitis B immune reconstitution.…”

Section: Introductionmentioning

confidence: 99%

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The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

Duan

Wei³

et al. 2015

Human Vaccines & Immunotherapeutics

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These authors equally contributed to the work.Keywords: ccc DNA, HBV reinfection, hepatitis B, liver transplantation, HBV DNA, vaccination Abbreviations: Abbreviations, Full names; HBV DNA, hepatitis B virus total DNA; ccc DNA, covalently closed circular DNA; PBMCs, peripheral blood mononuclear cells; PCR, polymerase chain reaction; anti-HBs, antibodies against hepatitis B surface antigen; HBIG, hepatitis B immunoglobulin; LT, liver transplantation; HBsAg, hepatitis B surface antigen; HBcAg, hepatitis B core antigen; HBsAb, hepatitis B surface antibody; HBeAg, hepatitis B e antigen; HBeAb, hepatitis B e antibody; HBcAb, hepatitis B core antibodyTo investigate the levels of hepatitis B virus total DNA (HBV DNA) and covalently closed circular (ccc) DNA in liver transplant recipients who received hepatitis B vaccination, including responders and non-responders, following liver transplantation due to hepatitis B-related diseases and to investigate the efficacy of hepatitis B immune reconstitution against HBV reinfection. Twenty responders and 34 non-responders were enrolled in the present study. The levels of HBV total DNA and ccc DNA in peripheral blood mononuclear cells (PBMCs) and the liver and plasma were detected by real-time polymerase chain reaction (PCR). Fifty-three blood samples and 38 liver allograft tissues were acquired. For the responders, the mean serum titer for anti-HBs (antibodies against hepatitis B surface antigen) was 289 (46.64-1000) IU/ml. Also for the responders, HBV total DNA was detected in PBMCs for one recipient and in the liver for another recipient, but ccc DNA was not detected in either of those 2 recipients. For the non-responders, HBV total DNA was detected in PBMCS for 2 recipients, neither of whom had ccc DNA. Also for the non-responders, HBV total DNA was detected in the livers of 3 recipients, 2 of whom also had ccc DNA. All responders had discontinued hepatitis B immunoglobulin (HBIG), and 13 responders had discontinued antiviral agents. One responder experienced HBV recurrence during the follow-up period. For the majority of liver transplant recipients, no HBV total DNA or ccc DNA was detected in the blood or liver. The lack of HBV total DNA and ccc DNA both in PBMCs and the liver in liver transplant recipients who received hepatitis B vaccination to prevent HBV reinfection should be a prerequisite for the withdrawal of HBIG and/or antiviral agents.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

Duan

Wei³

et al. 2015

Human Vaccines & Immunotherapeutics

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“…Otro enfoque ha sido intentar inducir la producción de anticuerpos anti-HBs con la utilización de vacuna contra el virus B 24,29,30 . El factor limitante de este enfoque ha sido que no todos los pacientes desarrollan títulos alto de anti-HBs y es probable que se necesite una vacuna más antigénica que la que se dispone actualmente [30][31][32][33][34] .…”

Section: Hepatitis Bunclassified

Recurrencia de la enfermedad hepática primaria después del trasplante hepático

2010

Rev. méd. Chile

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Liver disease recurrence after liver transplantationJorge rakela, M.D. Department of internalMedicine, Mayo clinic arizona, 13400 east shea Boulevard.scottsdale, aZ 85259, u.s.a.e-mail: rakela.jorge@mayo.edu E l trasplante hepático ha pasado a formar parte de las opciones terapéuticas de rutina en hepatología desde la década de 1980. En una primera etapa del desarrollo del trasplante hepático, la preocupación más importante era el manejo del rechazo agudo y crónico del injerto y de las infecciones en el paciente inmunosuprimido. Con el uso de ciclosporina y luego tacrolimus, estos problemas, aunque aún presentes, se han hecho menos frecuentes y más susceptibles de resolver eficazmente. En 1995, Pappo et al 1 de la Universidad de Pittsburgh, demostraron en 51 pacientes que habían recibido un hígado trasplantado y tenían síntomas clínicos y exámenes de laboratorio anormales, que la causa más común de disfunción era la recurrencia de la enfermedad hepática primaria, viral y no-viral. Encontraron que 17 de los 51 los cambios observados eran rev Med chile 2010; 138: 504-510

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“…Antiviral monoprophylaxis has been employed to reduce or eliminate the requirement of HBIG as an alternative strategy, [7][8][9][10] and the safety of HBV prophylaxis withdrawal has been investigated in selected HBV transplanted patients at low risk for HBV reactivation. 11 In addition, hepatitis B vaccination in transplant recipients might be a promising prophylaxis strategy for HBV reinfection, [12][13][14][15][16][17][18][19] and this has enabled some recipients to generate sufficiently high anti-HBs titres; it also offers a good cost-effect ratio. HBIG and/or NA withdrawal might thus be safe and effective for responders to hepatitis B vaccination after liver transplantation, but there are limited data on such long-term results in these recipients.…”

mentioning

confidence: 99%

Long‐term consequences of stopping HBIG and/or nucleotide analogues in liver transplant recipients administered hepatitis B vaccination to prevent HBV reinfection

Duan

Tian

Lin

et al. 2019

Journal of Viral Hepatitis

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Background The long‐term administration of nucleotide analogues (NAs) and hepatitis B immune globulin (HBIG) comprises standard prophylaxis for patients with hepatitis B virus (HBV)‐related liver diseases to prevent HBV reinfection after liver transplantation (LT). However, prolonging the prophylaxis strategy involves safety issues, such as the development of escape mutations and/or emerging resistant strains, and is also associated with high costs; further, it remains unclear how long prophylactic treatment should be continued. Method Liver transplantation recipients responding to hepatitis B vaccination due to HBV‐related liver diseases were retrospectively analysed after stopping HBIG and/or NAs, administered to prevent HBV reinfection, after long‐term follow‐up. The safety and effectiveness of the strategy were then evaluated for these responders. Result Seventy‐eight responders were enrolled. All responders discontinued HBIG, among which 36 stopped both HBIG and NAs. During follow‐up, four recipients experienced HBV reinfection, which was associated with HBV escape mutations, after the withdrawal of both HBIG and NAs. No death or graft loss occurred in recipients during the follow‐up period. Conclusion A careful withdrawal of HBIG and/or NAs is feasible and safe for responders to hepatitis B vaccination receiving transplants for HBV‐related liver diseases.

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Hepatitis B vaccination after liver transplantation as a strategy to discontinue prophylaxis with hepatitis B immune globulin

Cited by 3 publications

References 11 publications

The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

Recurrencia de la enfermedad hepática primaria después del trasplante hepático

Long‐term consequences of stopping HBIG and/or nucleotide analogues in liver transplant recipients administered hepatitis B vaccination to prevent HBV reinfection

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