Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok10330, Thailand.
World J Gastroenterol. 2018 Feb 14;24(6):752-762. doi: 10.3748/wjg.v24.i6.752.
To assess the seroprevalence of hepatitis B virus (HBV) immunity among previously vaccinated pediatric liver transplant recipients and present a case report of hepatitis B infection after liver transplantation.
This 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.
In 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% ( = 26) at one year, 57% ( = 7) at two years and 82% ( = 17) at > three years following liver transplantation. The potential factors relating to HBV immunity loss after liver transplantation were identified as anti-HBs ( = 0.002), serum albumin ( = 0.04), total bilirubin ( = 0.001) and direct bilirubin ( = 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.
The 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.
评估既往接种过乙型肝炎病毒（HBV）疫苗的儿科肝移植受者的 HBV 免疫血清阳性率，并报告 1 例肝移植后乙型肝炎感染病例。
本研究聚焦于接受过主 动 免 疫 的慢性肝病儿童，纳入 2001 年 5 月至 2017 年 6 月期间肝移植前后具有完整抗-HBs 数据集的患儿。回顾性分析潜在的与 HBV 免疫丧失相关的因素。
共纳入 50 例患儿。肝移植后进行抗-HBs 检测的平均时间为 2.53 ± 2.11 年。肝移植前后的平均抗-HBs 水平分别为 584.41 ± 415.45 和 58.56 ± 6.40 IU/L。1 年、2 年和 > 3 年时，参与者的非免疫率（抗-HBs < 10 IU/L）分别为 46%（= 26）、57%（= 7）和 82%（= 17）。肝移植后 HBV 免疫丧失的潜在相关因素为抗-HBs（= 0.002）、血清白蛋白（= 0.04）、总胆红素（= 0.001）和直接胆红素（= 0.003）。1 例 5 岁男孩因胆汁性肝硬化接受 4 剂 HBV 疫苗接种，抗-HBs 滴度> 1000 IU/L，并接受了肝移植；其抗-HBc 阴性的父亲是供体。肝移植后，男孩发生肝动脉狭窄累及下腔静脉吻合口，行血管成形术 3 次。还接受了依诺肝素皮下注射 5 个月和 20 次血液成分输注。肝移植后 3 年 10 个月，检测到肝功能异常，HBsAg、HBeAg 和抗-HBc 检测结果均为阳性（分别为 2169.61、1706 和 8.45；截断值：< 1.00），HBV 病毒载量为 33212320 IU/mL。
本研究表明，肝移植后 HBV 免疫丧失出乎意料地常见。在本病例报告中，尽管移植前的抗-HBs 水平较高，但不幸的是，在儿童肝移植后失去乙型肝炎免疫后，发生了感染。
