Response to Booster Hepatitis B Vaccines in Liver-Transplanted Children Primarily Vaccinated in Infancy

Ni, Yen‐Hsuan; Ho, Ming‐Chih; Wu, Jiafeng; Chen, Huey‐Ling; Wu, Yao‐Ming; Hu, Rey‐Heng; Lee, Po‐Huang; Chang, Mei–Hwei

doi:10.1097/tp.0b013e318189064c

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…In this previous study, long-term and repetitive vaccine stimulation was shown to be an important method with which to create and cultivate an enhanced immune response in these immunocompromised patients. Similar to this study, a few pediatric studies have reported the use of intermittent vaccination reinforcement, or booster vaccination, to maintain spontaneous anti-HBs production in children after liver transplantation[ 10 , 24 , 25 ]. For example, Ni[ 25 ] studied both the humoral and cellular immunity of booster hepatitis B vaccines in children after liver transplantation and demonstrated that the immunological response following a booster dose appeared to be adequate, at least over the short term (2 mo assessment period).…”

Section: Discussionsupporting

confidence: 58%

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

Sintusek¹,

Posuwan²,

Wanawongsawad³

et al. 2018

WJG

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AIMTo assess the seroprevalence of hepatitis B virus (HBV) immunity among previously vaccinated pediatric liver transplant recipients and present a case report of de novo hepatitis B infection after liver transplantation.METHODSThis study focused on children with chronic liver diseases who received primary hepatitis B immunization and had a complete dataset of anti-HBs before and after liver transplantation between May 2001 and June 2017. Medical records were retrospectively reviewed for potential factors relating to HBV immunity loss.RESULTSIn total, 50 children were recruited. The mean time from liver transplantation to anti-HBs testing was 2.53 ± 2.11 years. The mean anti-HBs levels before and after liver transplantation were 584.41 ± 415.45 and 58.56 ± 6.40 IU/L, respectively. The rate of non-immunity (anti-HBs < 10 IU/L) in the participants was 46% (n = 26) at one year, 57% (n = 7) at two years and 82% (n = 17) at > three years following liver transplantation. The potential factors relating to HBV immunity loss after liver transplantation were identified as anti-HBs (P = 0.002), serum albumin (P = 0.04), total bilirubin (P = 0.001) and direct bilirubin (P = 0.003) before liver transplantation. A five-year-old boy with biliary cirrhosis received 4 doses of HBV vaccine with an anti-HBs titer of > 1000 IU/L and underwent liver transplantation; his anti-HBc-negative father was the donor. After liver transplantation, the boy had stenosis of the hepatic artery up to the inferior vena cava anastomosis and underwent venoplasty three times. He also received subcutaneous injections of enoxaparin for 5 mo and 20 transfusions of blood components. Three years and ten months after the liver transplantation, transaminitis was detected with positive tests for HBsAg, HBeAg, and anti-HBc (2169.61, 1706 and 8.45, respectively; cutoff value: < 1.00) and an HBV viral load of 33212320 IU/mL.CONCLUSIONThe present study showed that loss of hepatitis B immunity after liver transplantation is unexpectedly common. In our case report, despite high levels of anti-HBs prior to transplantation, infection occurred at a time when, unfortunately, the child had lost immunity to hepatitis B after liver transplantation.

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Section: Discussionsupporting

confidence: 58%

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

Sintusek¹,

Posuwan²,

Wanawongsawad³

et al. 2018

WJG

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“…Most trials applied a multi dose scheme. In adult SOT recipients, the response rate was low ranging from 6.7% to 36% while in contrast, a high response rate was seen in the paediatric trials ranging from 63.6% to 100% (Figure 2, category B) [29]–[31]. Overall, response rate to HBV after transplantation in adult SOT recipients is poor while in paediatric SOT recipients a 58% (95 CI: 37%–80%) higher response rate was seen (p = 0.001 from meta-regression).…”

Section: Resultsmentioning

confidence: 99%

“…We identified seven trials on hepatitis B vaccination after SOT with publication dates ranging from 1992 to 2001 (Table 3, category B) [25]–[31]. Six trials were prospective uncontrolled while one trial was retrospective.…”

Section: Resultsmentioning

confidence: 99%

Serologic Vaccination Response after Solid Organ Transplantation: A Systematic Review

et al. 2013

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BackgroundInfectious diseases after solid organ transplantation (SOT) are one of the major complications in transplantation medicine. Vaccination-based prevention is desirable, but data on the response to active vaccination after SOT are conflicting.MethodsIn this systematic review, we identify the serologic response rate of SOT recipients to post-transplantation vaccination against tetanus, diphtheria, polio, hepatitis A and B, influenza, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitides, tick-borne encephalitis, rabies, varicella, mumps, measles, and rubella.ResultsOf the 2478 papers initially identified, 72 were included in the final review. The most important findings are that (1) most clinical trials conducted and published over more than 30 years have all been small and highly heterogeneous regarding trial design, patient cohorts selected, patient inclusion criteria, dosing and vaccination schemes, follow up periods and outcomes assessed, (2) the individual vaccines investigated have been studied predominately only in one group of SOT recipients, i.e. tetanus, diphtheria and polio in RTX recipients, hepatitis A exclusively in adult LTX recipients and mumps, measles and rubella in paediatric LTX recipients, (3) SOT recipients mount an immune response which is for most vaccines lower than in healthy controls. The degree to which this response is impaired varies with the type of vaccine, age and organ transplanted and (4) for some vaccines antibodies decline rapidly.ConclusionVaccine-based prevention of infectious diseases is far from satisfactory in SOT recipients. Despite the large number of vaccination studies preformed over the past decades, knowledge on vaccination response is still limited. Even though the protection, which can be achieved in SOT recipients through vaccination, appears encouraging on the basis of available data, current vaccination guidelines and recommendations for post-SOT recipients remain poorly supported by evidence. There is an urgent need to conduct appropriately powered vaccination trials in well-defined SOT recipient cohorts.

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“…Anti-HBs antibodies can be reliably measured by standardised tests, but no standardised method is yet available for measuring specific immune memory. In studies in which immune memory was shown by means of the increase in anti-HBs after booster vaccination, anti-HBs titres were mostly measured only once and at rather different time points, ranging from 10 days to 2 months post-booster [7,[18][19][20][21]. In addition, in some studies anamnestic response was defined as an increase in anti-HBs to ≥10 IU/l [21][22][23][24][25], in other studies as 4-fold increase in anti-HBs [5], and sometimes both criteria were applied [13,15,20,26].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of immune memory 10–15 years after primary hepatitis B vaccination

Hummel

Zitzmann

Erl

et al. 2016

Vaccine

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Response to Booster Hepatitis B Vaccines in Liver-Transplanted Children Primarily Vaccinated in Infancy

Abstract: Primary HBV vaccination or the booster dose(s) of HBV vaccine could provide adequate humoral and cellular immunity in children with LT.

Cited by 11 publications

References 23 publications

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

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

Serologic Vaccination Response after Solid Organ Transplantation: A Systematic Review

Characteristics of immune memory 10–15 years after primary hepatitis B vaccination

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