Is vaccination against hepatitis B infection indicated in patients waiting for or after orthotopic liver transplantation?

Chalasani, Naga; Smallwood, Gregory; Halcomb, Joanne; Fried, Michael; Boyer, MB Thomas D.

doi:10.1002/lt.500040208

Cited by 94 publications

(93 citation statements)

References 25 publications

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“…21 Similarly, in adult patients with cholestatic liver disease, a significantly better response to vaccination was seen as compared to noncholestatic forms of liver disease (43% vs. 7%). 22 The better immunogenicity of the adjuvanted HB-AS04 vaccine observed in this study confirms previous results in healthy subjects 16,17 as well as in prehemodialysis and hemodialysis patients. 23 Long-term protection after the HB-AS04 booster dose has not been evaluated in this study.…”

Section: Discussionsupporting

confidence: 91%

Immunogenicity and safety of an experimental adjuvanted hepatitis B candidate vaccine in liver transplant patients

et al. 2006

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Patients with chronic liver disease are at higher risk of hepatitis B (HB) virus infection before and after liver transplantation, and they commonly have a suboptimal immune response to HB vaccines. In this randomized trial, we compared the immunogenicity of primary vaccination with 2 doses of an experimental adjuvanted HB vaccine (adjuvant system 04 containing aluminium and monophosphoryl lipid A [HB-AS04] ) to that of 3 double doses of a licensed HB vaccine in 93 liver transplant candidates. Depending on the waiting list for liver transplantation, a booster dose of HB-AS04 or double booster dose of the licensed HB vaccine was given before or after surgery, at 6 to 12 months after initiation of the vaccination course. The percentage of subjects with seroprotective anti-HB surface antibody concentrations 1 month after booster was twice as high in the HB-AS04 group (60.0%), vs. patients in the comparator group (32.0%) (P ϭ 0.035). In subjects who did not undergo liver transplantation before administration of the booster, better immunogenicity results were obtained: 80% of subjects were seroprotected after HB-AS04 vaccination vs. 60% with the comparator (P ϭ 0.2302). Despite a slightly higher reactogenicity, the safety profile of the HB-AS04 vaccine was clinically acceptable. In conclusion, an improved antibody response was observed in liver transplant candidates with 3 doses of HB-AS04, as compared to 4 double doses of a comparator. Liver transplant candidates could benefit from the use of this experimental adjuvanted HB vaccine to further increase their protection against HB infection. Patients undergoing liver transplantation have an increased risk of exposure to hepatitis B (HB) virus, mainly due to transmission of the virus from the donor organ and, to a lesser extent, due to multiple transfusions of blood products. [1][2][3][4] To protect these patients against de novo HB infection acquired during or after Abbreviations: HB, hepatitis B; HBsAg, hepatitis B surface antigen; anti-HBs, antibody to hepatitis B surface antigen; AS04, adjuvant system 04 containing aluminium and monophosphoryl lipid A; GMC, geometric mean concentration; SAE, serious adverse event.

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Section: Discussionsupporting

confidence: 91%

Immunogenicity and safety of an experimental adjuvanted hepatitis B candidate vaccine in liver transplant patients

et al. 2006

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“…Confronted with the above-mentioned literature, [23][24][25][26] the satisfactory rate of seroconversion reached in our series can be accounted for by considering first the fact that we administered a double dose schedule of three 40-µg doses and additional complete courses of vaccination whenever the first one was ineffective, and second the long time elapsed after liver transplantation, which allowed a marked tapering of the immunosuppressive drugs. The poor rate of seroconversion obtained in those patients who had withdrawn steroid treatment most recently backs up the latter hypothesis.…”

Section: Discussionmentioning

confidence: 79%

“…Before long-term HBIG became the established HBV prophylactic treatment, HBV vaccine was usually administered perioperatively, together with short-term passive immunoprophylaxis, and continued thereafter in the postoperative phase 3,21,22 although with only anecdotal effectiveness. 5 On the other hand, reports on HBV vaccination in non-HBV adult liver transplant recipients have shown very low rates of seroconversion, [23][24][25] probably because of the fact that vaccination was administered before transplantation or immediately after. Our study attempts to induce anti-HBs seroconversion as a means to discontinue indefinite HBIG treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2000

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It is widely agreed that hepatitis B virus immunoglobulinSeveral reports have clearly shown that liver transplantation in patients with hepatitis B virus (HBV) infection-as defined by positivity for hepatitis B surface antigen (HBsAg)-is associated with a high rate of recurrence of HBV infection after transplantation, resulting in severe graft disease in most cases and in a significant decrease in both graft and patient survival. [1][2][3][4] It is widely accepted that the risk of HBV recurrence after liver transplantation is directly proportional to the level of viral replication before transplantation, with those recipients seropositive for HBeAg and HBV DNA by hybridization technique having the highest rate of recurrence after transplantation, irrespective of the type of liver disease. 2,4 Many prophylactic strategies have been proposed to prevent HBV infection of the graft, but only long-term passive immunoprophylaxis with HBV-specific immunoglobulin (HBIG) has obtained a significant reduction in the risk of HBV graft infection and in both graft and patient mortality after liver transplantation. [4][5][6][7] The presence of serum HBV DNA before transplantation is, however, a major predictor of lack of response to this prophylactic regimen.In light of these evidences, the European Concerted Action on Viral Hepatitis (EUROHEP) recommended in 1994 to refrain from transplanting chronic HBV carriers found to be positive for either hepatitis B e antigen (HBeAg) or HBV DNA by direct hybridization. Moreover, the rest of the recipients with HBV-related disease should receive HBIG immunoprophylaxis to maintain anti-HBs levels above 100 IU/L for at least 12 months after transplantation. 6 Currently, the beneficial effect of long-term HBIG administration has become widely accepted; still no consensus has been reached regarding the optimal duration of HBIG treatment. The rate of HBV graft infection recurrence 12 months after liver transplantation seems to be much decreased but it can still undoubtedly occur. 4,6,[8][9][10] Moreover the finding of HBV DNA in peripheral mononuclear blood beyond 12 months of effective HBIG prophylaxis argues in favor of a potentially indefinite risk of graft infection. 11-13 As a consequence, most liver transplant centers are currently administering HBIG on a life-long basis. Because HBIG use is highly expensive, an alternative strategy aiming at the discontinuation of HBIG prophylaxis during the second year of treatment would be an important cost-effective measure. We present here an assessment of the efficacy of a new prophylactic strategy consisting of the discontinuation of HBIG administration followed by active immunization with HBV vaccination in patients transplanted for HBVrelated liver diseases. PATIENTS AND METHODSPatients. Between July 1990 and April 1996, 36 HBsAg-positive recipients were submitted to liver transplantation at the Hospital Abbreviations: HBV, hepatitis B virus; HBsAg, hepatitis B virus surface antigen; HBIG, hepatitis B virus immunoglobulin; HBeAg, hepatitis B vi...

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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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Is vaccination against hepatitis B infection indicated in patients waiting for or after orthotopic liver transplantation?

Cited by 94 publications

References 25 publications

Immunogenicity and safety of an experimental adjuvanted hepatitis B candidate vaccine in liver transplant patients

Immunogenicity and safety of an experimental adjuvanted hepatitis B candidate vaccine in liver transplant patients

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

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

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