Adoptive transfer of HBV immunity by kidney transplantation and the effect of postoperative vaccination

Dahmen, Uta; Gu, Yanli; Dirsch, Olaf; Li, Jun; Polywka, Susanne; Doebel, L.; Shen, Kai; Broelsch, Christoph E.

doi:10.1016/s0166-3542(02)00068-2

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Studies in animal models developed in mice14, in rats15 and in woodchucks16 confirmed that indeed immunity to HBV can be adoptively transferred even under conditions of immune suppression employed in organ transplantation. This was also reported in experimental heart and kidney transplantation 17. Finally, in the woodchuck model, liver transplantation from woodchuck hepatitis virus immune donors to woodchucks with persistent woodchuck hepatitis virus infection enabled control of the viral infection in transplanted animals 16.…”

supporting

confidence: 53%

Adoptive transfer of immunity to HBV in liver transplant patients:A step forward toward the proof of concept for therapeutic vaccination or a transient immunologic phenomenon?

Shouval

2006

Liver Transpl

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In this issue of the journal, Dr. Luo and co-workers have identified intra-graft hepatitis B virus (HBV) specific lymphocytes in HBV immune liver donors, (most of whom were live donors) and correlated their findings with the liver transplant recipients' humoral immune responses to HBsAg. 1 HBV specific T and B cells were identified in 59% and 28% of liver grafts respectively in 32 donors. After liver transplantation, almost half of the transplanted patients with chronic HBV developed anti-HBs seroconversion which correlated with the number of donor graft derived HBsAg specific T cells. The investigators suggest that these donor derived HBV specific lymphocyte may be the vehicle through which adoptive transfer of immunity is transferred from HBV immune donors to liver graft recipients with persistent HBV infection. This important study provides for the first time evidence on HBV specificity of intrahepatic lymphocytes isolated from human liver grafts and transplanted to patients with chronic HBV infection. The study sheds further light on the presumed mechanism involved in adoptive transfer of immunity in the setting of parenchymatous organ transplantation. Furthermore, it may take us one step forward in the quest for developing new means for the so called "vaccinotherapy" for controlling persistent HBV infection.Analysis of the reported data requires a short look back on the progress already achieved in this exciting area of clinical research.Patients with acute HBV infection who recover spontaneously are able to clear HBV from the circulation by mounting an effective innate, cellular and humoral immune response leading to long-term, usually life-long immunity. 2,3 Some patients may clear the virus from the circulation, but remain with occult HBV infection with covalently closed circular (ccc) HBV-DNA "hiding" in hepatocytes. Yet, these recovered patients rarely reactivate HBV infection in the presence of an intact immune system and "immune memory" which serve as a gate keeper for prevention or suppression of viral replication and its consequences. In contrast, patients with persistent HBV infection are often tolerant to HBV and unable to mount an effective cellular and humoral immune response toward nucleocapsid and envelope proteins of the virus. This is also true for HBV patients undergoing liver transplantation who in addition to this immunologic defect are also immune suppressed by pharmacologic agents for prevention of graft rejection.Current strategies for protection of HBV liver transplant recipients at risk include lifelong monotherapy with hepatitis B immune globulin (HBIG) or a nucleoside analogue or combination therapy using the two agents simultaneously and indefinitely or at least for a defined period, followed by life-long monotherapy. 4 These strategies, which also include pre-transplant suppression of HBV viral load, have led to an impressive success rate in prevention of HBV graft re-infection in about 90% of patients treated with combination therapy. However, although the risk of graft re-infec...

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supporting

confidence: 53%

Adoptive transfer of immunity to HBV in liver transplant patients:A step forward toward the proof of concept for therapeutic vaccination or a transient immunologic phenomenon?

Shouval

2006

Liver Transpl

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“…A different explanation of the serology results includes passive transfer of donor antibodies at the time of transplantation or transfer of donor lymphocytes with the graft, a phenomenon already depicted in organ transplantation . However, transmission of syphilis remains most likely, as indicated by progressive change with rise in antibody titer, detection of IgM (absent in the donor), recipient failure to show detectable levels of other antibodies that were also present in the donor (i.e., CMV IgG), and persistence of treponemal antibodies for 6 months.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic transmission of Treponema pallidum (syphilis) through deceased donor liver transplantation

Tariciotti

Das

Dori

et al. 2012

Transplant Infectious Dis

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A 55-year-old woman underwent liver transplantation (LT) with a graft from a deceased donor. Mandatory pre-donation investigations showed positive syphilis serology that was available only after the transplant, with high Treponema pallidum particle agglutination assay titer compatible with donor syphilis infection. Despite the institution of appropriate post-exposure prophylaxis, the recipient demonstrated latent seroconversion; however, liver graft function improved without evidence of syphilitic hepatitis or other manifestations of the disease. Through this first reported case of asymptomatic transmission of syphilis following LT, we highlight the investigations and treatment strategies for donor-derived syphilis in liver transplant recipients. This report supplements the existing limited evidence on safe use of infected grafts from syphilitic donors through appropriate post-exposure prophylaxis.

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“…Alternative explanations for the results include passive transfer of donor antibodies at the time of transplantation or the transfer of donor lymphocytes with the graft, a phenomenon increasingly recognized in solid organ transplantation (13,14). The latter may lead to the establishment of a microchimeric state in the recipient with subsequent antibody production by donor-derived lymphocytes accounting for serologic changes post-transplantation.…”

Section: Discussionmentioning

confidence: 99%

Transmission of Syphilis by Solid Organ Transplantation

Cortes

Afzali²,

MacLean³

et al. 2006

American Journal of Transplantation

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Two organ recipients developed serologic evidence of syphilis infection after renal transplantation from a common deceased donor with a history of treated syphilis. Testing of donor serum for syphilis, which occurred after transplantation, gave results interpreted as consistent with past infection. However, subsequent serologic results in the recipients suggested transmission of infection at transplantation due to active infection of the donor. This may be explained by recent donor re-infection in view of the current syphilis epidemic in the United Kingdom. An initial error in the treatment of recipients further served to highlight unfamiliarity in managing this resurgent infection in the context of organ transplantation.

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Adoptive transfer of HBV immunity by kidney transplantation and the effect of postoperative vaccination

Cited by 5 publications

References 16 publications

Adoptive transfer of immunity to HBV in liver transplant patients:A step forward toward the proof of concept for therapeutic vaccination or a transient immunologic phenomenon?

Adoptive transfer of immunity to HBV in liver transplant patients:A step forward toward the proof of concept for therapeutic vaccination or a transient immunologic phenomenon?

Asymptomatic transmission of Treponema pallidum (syphilis) through deceased donor liver transplantation

Transmission of Syphilis by Solid Organ Transplantation

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