Vaccination against Hepatitis B in Patients with Chronic Liver Disease Awaiting Liver Transplantation

Horlander, John C.; BOYLE, NANCY; Manam, Rajesh; SCHENK, MELINDA; Herring, Scott; Kwo, Paul Y.; Lumeng, Lawrence; Chalasani, Naga

doi:10.1097/00000441-199911000-00004

Cited by 52 publications

(58 citation statements)

References 16 publications

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“…Pre-LT vaccination to provide endogenous anti-HBs is unlikely to be successful in the vast majority of patients. A recent North American study demonstrated only 37% response rate to double-dose hepatitis B vaccine in cirrhotics without history of hepatitis B infection (18). This contradicts data from some Asian studies, though the higher seroconversion rates in Asia may correlate with a higher underlying prevalence of HBV exposure (40).…”

Section: Discussionmentioning

confidence: 96%

“…This mutant could be preexisting in the donor graft or potentially induced by HBIg prophylaxis or lamivudine therapy as has been previously described (16,17). The loss of protective anti-HBs serologies after known response to vaccination has been reported to range from 27% to 34% in studies with 3 years of follow-up (18)(19)(20)(21). In addition, loss of antiHBs is not uncommon following LT, even in patients with previous HBV exposure.…”

Section: Discussionmentioning

confidence: 99%

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Case Report of Lamivudine-Resistant Hepatitis B Virus Infection Post Liver Transplantation from a Hepatitis B Core Antibody Donor

Yen¹,

Bonatti²,

Mendez

et al. 2006

American Journal of Transplantation

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The use of allografts from donors with hepatitis B core antibody in liver transplantation (LT) is associated with the risk of de novo hepatitis B virus (HBV) infection. Prophylaxis using hepatitis B Immune globulin (HBIg) and lamivudine alone or in combination has been reported. Yet, there are no standardized regimens and long-term efficacy is not known. We report a case of a patient who underwent LT for alcoholic liver disease who received an allograft from a donor with Hepatitis B core antibody. The patient had no previous exposure to HBV, was vaccinated against HBV, and had demonstrated Hepatitis B surface antibody present in serum before and 6 months after transplantation. Prophylaxis with short-term HBIg (1 week) and indefinite lamivudine was given. De novo HBV infection developed more than 3 years after LT with a lamivudineresistant polymerase mutant containing the rtM204I and rtl180L/M mutations. We reviewed the risk of de novo post-LT HBV infection in recipients of livers from hepatitis B core antibody positive donors. High risk were HBV naïve recipients, moderate risk recipients had isolated hepatitis B surface antibody (anti-HBs) or hepatitis B core antibody (anti-HBc), while low-risk recipients had both anti-HBs and anti-HBc. We reviewed prophylaxis protocols reported in the literature and made recommendations for management.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Case Report of Lamivudine-Resistant Hepatitis B Virus Infection Post Liver Transplantation from a Hepatitis B Core Antibody Donor

Yen¹,

Bonatti²,

Mendez

et al. 2006

American Journal of Transplantation

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“…It is also clinically well recognized that cirrhotic patients have suboptimal responses to vaccines such as the hepatitis B vaccine. In several series, HBV vaccinations in cirrhotic patients yielded response rates from 13 to 54% [28,29] with minimal improvement by doubling the dose [30], much poorer than the results in noncirrhotic patients. In a study of conjugated pneumococcal vaccine in liver disease, cirrhotic patients showed transient exaggerated early IgM and IgA production but impaired total IgG response suggesting defective IgG class-switching among cirrhotic patients relative to healthy donors [31].…”

Section: Discussionmentioning

confidence: 99%

Peripheral CD27−CD21− B-cells represent an exhausted lymphocyte population in hepatitis C cirrhosis

Doi

Tanoue

Kaplan

2014

Clinical Immunology

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Hepatitis C cirrhosis is associated with a profound disappearance of memory B-cells. We sought to determine if this loss is associated with the expansion of the CD27 − CD21 − tissue-like memory B-cells with features of B-cell exhaustion. To this end, we quantified the frequency of CD27 − CD21 − B-cells in healthy, non-cirrhotic HCV-infected, and cirrhotic patients. We examined the expression of putative inhibitory receptors, the proliferative and immunoglobulin-secreting capacity of CD27/CD21-defined B-cell subsets upon B-cell receptor and/or CD40 stimulation. We found that CD27 − CD21 − B-cells are significantly increased in frequency relative to healthy donors in HCV-infected patients. CD27 − CD21 − B-cells were hypoproliferative relative to naïve and resting memory B-cells upon agonistic stimulation, but retained similar capacity for antibody secretion. Conclusion: CD27 − CD21 − tissue-like memory B-cells with exhausted proliferation circulate at increased frequency in cirrhotic and non-cirrhotic HCV-infected patients. This B-cell subset does not appear anergic, exhibiting immunoglobulin-secreting capacity on CD40 agonism indistinguishable from other CD27/CD21-defined B-cell subsets.

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“…Tampoco se observa un incremento en los valores plasmáticos basales elevados de FNT-α con la vacuna. La tasa de seroconversión en pacientes con cirrosis es inferior y no supera el 16 ó 37% según se utilice una dosis estándar o una doble dosis en el esquema 47 .…”

Section: Diagnóstico Manejo Y Prevención De Infecciones En Pacientesunclassified

Diagnóstico, manejo y prevención de infecciones en pacientes con cirrosis hepática

Fica

2005

Rev. chil. infectol.

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Vaccination against Hepatitis B in Patients with Chronic Liver Disease Awaiting Liver Transplantation

Abstract: Although the response rate to double-dose recombinant vaccines is higher than the previously reported response to single-dose vaccine, it still is less than optimal.

Cited by 52 publications

References 16 publications

Case Report of Lamivudine-Resistant Hepatitis B Virus Infection Post Liver Transplantation from a Hepatitis B Core Antibody Donor

Case Report of Lamivudine-Resistant Hepatitis B Virus Infection Post Liver Transplantation from a Hepatitis B Core Antibody Donor

Peripheral CD27−CD21− B-cells represent an exhausted lymphocyte population in hepatitis C cirrhosis

Diagnóstico, manejo y prevención de infecciones en pacientes con cirrosis hepática

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