Hepatitis B immunoglobulin discontinuation followed by hepatitis B virus vaccination: A new strategy in the prophylaxis of hepatitis B virus recurrence after liver transplantation

被引:181
作者
Sanchez-Fueyo, A
Rimola, A
Grande, L
Costa, J
Mas, A
Navasa, M
Cirera, I
Sanchez-Tapias, JM
Rodes, J
机构
[1] Hosp Clin Barcelona, Liver Unit, Dept Microbiol, E-08036 Barcelona, Spain
[2] Inst Clin Malalties Digest, Barcelona, Spain
关键词
D O I
10.1002/hep.510310233
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
It is widely agreed that hepatitis B virus immunoglobulin (HBIG) should be administered for at least 12 months to patients transplanted for hepatitis B virus (HBV)-related diseases to prevent HBV recurrence. No data are available, however, on how long this treatment should be used, and most centers currently administer HBIG on a life-long basis. Herein, we report the results of a new prophylactic strategy aiming at the discontinuation of HBIG treatment and consisting of the administration of double dose recombinant HBV vaccine (0, 1-, and 6-month schedule) to liver transplant recipients fulfilling the following criteria: (1) liver transplantation for conditions related to nonreplicative HBV infection (hepatitis B surface antigen [HBsAg] positive, hepatitis B e antigen [HBeAg] negative, and HBV DNA negative); (2) at least 18 months of HBIG administration; and (3) no HBV infection recurrence, normal or slightly altered liver graft function, and low-grade immunosuppression at the time of vaccination. Seventeen patients received HBV vaccination and 14 of them (82%) developed protective serum titers of anti-HBs (>10 IU/L). Six patients seroconverted after a first course of vaccination, whereas 8 patients required a second course (3 additional doses of vaccine). Responding patients were followed for a median of 14 months (range, 3-50) after seroconversion. During this period no HBV recurrence occurred and in only 2 patients a decrease of anti-HBs titers below 10 UI/L was observed. Our data suggest that in selected liver transplant recipients, posttransplantation HBV vaccination may be a useful and cost-effective strategy in the prophylaxis of HBV recurrence, allowing the discontinuation of life-long HBIG treatment.
引用
收藏
页码:496 / 501
页数:6
相关论文
共 31 条
  • [21] HEPATITIS-B VIRUS REINFECTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION - SEROLOGICAL AND CLINICAL IMPLICATIONS
    OGRADY, JG
    SMITH, HM
    DAVIES, SE
    DANIELS, HM
    DONALDSON, PT
    TAN, KC
    PORTMANN, B
    ALEXANDER, GJM
    WILLIAMS, R
    [J]. JOURNAL OF HEPATOLOGY, 1992, 14 (01) : 104 - 111
  • [22] HEPATITIS-B AND LIVER-TRANSPLANTATION - PROBLEMS AND PROMISES
    PERRILLO, RP
    MASON, AL
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (25) : 1885 - 1887
  • [23] Restrepo J C, 1996, Gastroenterol Hepatol, V19, P491
  • [24] PASSIVE IMMUNOPROPHYLAXIS AFTER LIVER-TRANSPLANTATION IN HBSAG-POSITIVE PATIENTS
    SAMUEL, D
    BISMUTH, A
    MATHIEU, D
    ARULNADEN, JL
    REYNES, M
    BENHAMOU, JP
    BRECHOT, C
    BISMUTH, H
    [J]. LANCET, 1991, 337 (8745) : 813 - 815
  • [25] Samuel D, 1995, Liver Transpl Surg, V1, P270, DOI 10.1002/lt.500010416
  • [26] Samuel D, 1998, HEPATOLOGY, V28, p313A
  • [27] LIVER-TRANSPLANTATION IN EUROPEAN PATIENTS WITH THE HEPATITIS-B SURFACE-ANTIGEN
    SAMUEL, D
    MULLER, R
    ALEXANDER, G
    FASSATI, L
    DUCOT, B
    BENHAMOU, JP
    BISMUTH, H
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (25) : 1842 - 1847
  • [28] Prophylaxis in liver transplant recipients using a fixed dosing schedule of hepatitis B immunoglobulin
    Terrault, NA
    Zhou, S
    Combs, C
    Hahn, JA
    Lake, JR
    Roberts, JP
    Ascher, NL
    Wright, TL
    [J]. HEPATOLOGY, 1996, 24 (06) : 1327 - 1333
  • [29] ORTHOTOPIC LIVER-TRANSPLANTATION FOR PATIENTS WITH HEPATITIS-B VIRUS RELATED LIVER-DISEASE
    TODO, S
    DEMETRIS, AJ
    VANTHIEL, D
    TEPERMAN, L
    FUNG, JJ
    STARZL, TE
    [J]. HEPATOLOGY, 1991, 13 (04) : 619 - 626
  • [30] WAGNER D, 1994, CLIN INVESTIGATOR, V72, P350