High prevalence of hepatitis B-antibody loss and a case report of<i>de novo</i>hepatitis B virus infection in a child after living-donor liver transplantation

Sintusek, Palittiya; Posuwan, Nawarat; Wanawongsawad, Piyaporn; Jitraruch, Suttiruk; Poovorawan, Yong; Chongsrisawat, Voranush

doi:10.3748/wjg.v24.i6.752

Cited by 15 publications

(12 citation statements)

References 29 publications

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“…This is particularly worrying, as Leung et al found insufficient antibody titers in in 67% of fully vaccinated children with Hepatitis B after liver transplantation [16]. Moreover, despite complete HBV vaccination, infection may occur post-transplant as case reports suggest [17].…”

Section: Discussionmentioning

confidence: 99%

Under-Vaccination in Pediatric Liver Transplant Candidates with Acute and Chronic Liver Disease—A Retrospective Observational Study of the European Reference Network TransplantChild

Laue

Demir²,

Debray³

et al. 2021

Children

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Infection is a serious concern in the short and long term after pediatric liver transplantation. Vaccination represents an easy and cheap opportunity to reduce morbidity and mortality due to vaccine-preventable infection. This retrospective, observational, multi-center study examines the immunization status in pediatric liver transplant candidates at the time of transplantation and compares it to a control group of children with acute liver disease. Findings show only 80% were vaccinated age-appropriately, defined as having received the recommended number of vaccination doses for their age prior to transplantation; for DTP-PV-Hib, less than 75% for Hepatitis B and two-thirds for pneumococcal conjugate vaccine in children with chronic liver disease. Vaccination coverage for live vaccines is better compared to the acute control group with 81% versus 62% for measles, mumps and rubella (p = 0.003) and 65% versus 55% for varicella (p = 0.171). Nevertheless, a country-specific comparison with national reference data suggests a lower vaccination coverage in children with chronic liver disease. Our study reveals an under-vaccination in this high-risk group prior to transplantation and underlines the need to improve vaccination.

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Section: Discussionmentioning

confidence: 99%

Under-Vaccination in Pediatric Liver Transplant Candidates with Acute and Chronic Liver Disease—A Retrospective Observational Study of the European Reference Network TransplantChild

Laue

Demir²,

Debray³

et al. 2021

Children

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“…Consequently, serology testing and immunization may be valuable in these groups. There is a reported case in which de novo hepatitis B infection was diagnosed 3 years after a liver transplant despite the recipient having undergone complete hepatitis B immunization pre-transplant[ 26 ]. This demonstrates that complete hepatitis B immunization pre-liver transplant does not guarantee post-transplant protection.…”

Section: Discussionmentioning

confidence: 99%

“…That case prompted us to instigate a protocol for reimmunization and hepatitis B surface antibody monitoring every 3-6 mo to maintain a protective level of > 100 mIU/mL. De novo hepatitis B in the aforementioned boy who had hepatitis B surface antibody > 1000 mIU/mL pretransplant[ 26 ] may reflect waning immunity post-liver transplant. As well as vaccination, research evaluating the humoral and cellular immunity evoked by each vaccine should be conducted to determine vaccination schedules and the antibody parameters required to prevent VPIs more effectively.…”

Section: Discussionmentioning

confidence: 99%

Immunization status and hospitalization for vaccine-preventable and non-vaccine-preventable infections in liver-transplanted children

Sintusek¹,

Poovorawan²

2021

WJH

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BACKGROUND Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children. Immunization strategies to prevent vaccine-preventable infections (VPIs) can effectively minimize this infection burden. However, data on age-appropriate immunization and VPIs in children after liver transplant in Asia are limited. AIM To evaluate the immunization status, VPIs and non-VPIs requiring hospitalization in children who have undergone a liver transplant. METHODS The medical records of children who had a liver transplant between 2004 and 2018 at King Chulalongkorn Memorial Hospital (Bangkok, Thailand) were retrospectively reviewed. Immunization status was evaluated via their vaccination books. Hospitalization for infections that occurred up to 5 years after liver transplantation were evaluated, and divided into VPIs and non-VPIs. Hospitalizations for cytomegalovirus and Epstein-Barr virus were excluded. Severity of infection, length of hospital stay, ventilator support, intensive care unit requirement, and mortality were assessed. RESULTS Seventy-seven children with a mean age of 3.29 ± 4.17 years were included in the study, of whom 41 (53.2%) were female. The mean follow-up duration was 3.68 ± 1.45 years. Fortyeight children (62.3%) had vaccination records. There was a significant difference in the proportion of children with incomplete vaccination according to Thailand’s Expanded Program on Immunization (52.0%) and accelerated vaccine from Infectious Diseases Society of America (89.5%) ( P < 0.001). Post-liver transplant, 47.9% of the children did not catch up with age-appropriate immunizations. There were 237 infections requiring hospitalization during the 5 years of follow-up. There were no significant differences in hospitalization for VPIs or non-VPIs in children with complete and incomplete immunizations. The risk of serious infection was high in the first year after receiving a liver transplant, and two children died. Respiratory and gastrointestinal systems were common sites of infection. The most common pathogens that caused VPIs were rotavirus, influenza virus, and varicella-zoster virus. CONCLUSION Incomplete immunization was common pre- and post-transplant, and nearly all children required hospitalization for non-VPIs or VPIs within 5 years post-transplant. Infection severity was high in the first year post-transplant.

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“…However, a booster dose is not indicated if they had been primarily immunised, because the rapid anamnestic response could occur after HepB exposure [4]. Unlike healthy persons, disappearance of HB antibodies in liver-transplanted children might indicate loss of protection, as evidenced by de novo HepB infection (DNH) [5]. There has been no cut-off anti-HB level that is adequate for DNH prevention.…”

Section: Introductionmentioning

confidence: 99%

Safety and Immunogenicity of Standard and Double Doses of Hepatitis B Vaccine in Children after Liver Transplantation: An Open-Label, Randomised Controlled Trial

et al. 2022

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A high prevalence of hepatitis B (HepB) antibody loss after liver transplantation (LT) and de novo HepB infection (DNH) was documented, hence revaccination to prevent DNH is crucial. This study aimed to compare the safety and immunogenicity of two HepB vaccine regimens in liver-transplanted children. Liver-transplanted children who were previously immunised but showed HepB surface antibodies (anti-HBs) ≤ 100 mIU/mL were randomised to receive a standard three-dose (SD) and double three-dose (DD) vaccine intramuscularly in months 0–1–6. Anti-HBs and T-cell-specific response to the HepB antigen were assessed. A total of 61 children (54.1% male, aged 1.32 ± 1.02 years) completed the study without any serious adverse reaction. The seroprotective rate was 69.6% vs. 60% (p = 0.368) and 91.3% vs. 85% (p = 0.431) in SD and DD after the first and third 3-dose vaccinations, respectively. The geometric mean titre (95% confidence interval) of anti-HBs in SD and DD were 443.33 (200.75–979.07) vs. 446.17 (155.58–1279.50) mIU/mL, respectively, at completion. Numbers of interferon-γ-secreting cells were higher in hyporesponders/responders than in nonresponders (p = 0.003). The significant factors for the immunologic response to HepB vaccination were anti-HB levels prevaccination, tacrolimus trough levels, and time from LT to revaccination. SD and DD had comparative immunogenicity and were safe for liver-transplanted children who were previously immunised.

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High prevalence of hepatitis B-antibody loss and a case report ofde novohepatitis B virus infection in a child after living-donor liver transplantation

Cited by 15 publications

References 29 publications

Under-Vaccination in Pediatric Liver Transplant Candidates with Acute and Chronic Liver Disease—A Retrospective Observational Study of the European Reference Network TransplantChild

Under-Vaccination in Pediatric Liver Transplant Candidates with Acute and Chronic Liver Disease—A Retrospective Observational Study of the European Reference Network TransplantChild

Immunization status and hospitalization for vaccine-preventable and non-vaccine-preventable infections in liver-transplanted children

Safety and Immunogenicity of Standard and Double Doses of Hepatitis B Vaccine in Children after Liver Transplantation: An Open-Label, Randomised Controlled Trial

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