Chancharoenthana Wiwat, Leelahavanichkul Asada, Udomkarnjananun Suwasin, Wattanatorn Salin, Avihingsanon Yingyos, Praditpornsilpa Kearkiat, Tungsanga Kriang, Eiam-Ong Somchai, Townamchai Natavudh
Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Open Forum Infect Dis. 2018 Dec 16;6(1):ofy342. doi: 10.1093/ofid/ofy342. eCollection 2019 Jan.
Despite the importance of hepatitis B virus (HBV) immunization in kidney transplantation (KT), data are lacking on fluctuations in hepatitis B surface antibody (anti-HBsAb) levels and optimal levels for KT recipients.
The study consisted of anti-HBsAb-positive recipients aged 18-70 years at the time of the KT. Recipients with anti-HBsAb <100 IU/L received a single booster HBV vaccination, and anti-HBsAb was measured at baseline and 3, 6, 12, 18, and 24 months post-KT. Anti-HBsAb, quantitative HBV deoxyribonucleic acid testing (12 and 24 months post-KT), and hepatitis B core-related antigen (24 months post-KT) were evaluated in recipients with anti-HBsAb >100 IU/L who received a hepatitis B surface antigen positive renal allograft.
Seventy-six of 257 (29.6%) KT recipients with anti-HBsAb <100 IU/L at the time of enrollment received a single booster of HBV vaccination. Anti-HBsAb levels increased (≥100 IU/L) 1 and 3 months post-booster dose in 86% and 93% of cases, respectively. Anti-HBsAb levels were ≥100 IU/L in 95% of these recipients 6 months post-booster dose. Among 181 (70%) recipients with anti-HBsAb ≥100 IU/L without a booster dose, anti-HBsAb gradually decreased after the KT from 588 IU/L at baseline to 440 and 382 IU/L 3 and 6 months post-KT, respectively ( < .01).
To ensure optimal immunity against HBV, KT recipients should first be stratified according to their risk of HBV reactivation. Kidney transplantation recipients of renal allografts from HBV nonviremic or viremic donors should be reimmunized when their anti-HBsAb titers are <250 IU/L. A cutoff level of 100 IU/L is recommended in other cases.
尽管乙型肝炎病毒（HBV）免疫接种在肾移植（KT）中很重要，但关于肾移植受者乙肝表面抗体（抗-HBsAb）水平的波动情况以及最佳水平的数据却很缺乏。
该研究纳入了肾移植时年龄在18至70岁的抗-HBsAb阳性受者。抗-HBsAb<100 IU/L的受者接受了一次乙肝疫苗加强接种，并在肾移植基线时以及肾移植后3、6、12、18和24个月测量抗-HBsAb水平。对接受乙肝表面抗原阳性肾移植且抗-HBsAb>100 IU/L的受者进行了抗-HBsAb、定量HBV脱氧核糖核酸检测（肾移植后12个月和24个月）以及乙肝核心相关抗原检测（肾移植后24个月）。
257名入组时抗-HBsAb<100 IU/L的肾移植受者中，76名（29.6%）接受了一次乙肝疫苗加强接种。分别在加强接种后1个月和3个月，86%和93%的病例抗-HBsAb水平升高（≥100 IU/L）。在加强接种后6个月，95%的这些受者抗-HBsAb水平≥100 IU/L。在181名（70%）未接受加强接种且抗-HBsAb≥100 IU/L的受者中，肾移植后抗-HBsAb逐渐下降，从基线时的588 IU/L分别降至肾移植后3个月和6个月的440 IU/L和382 IU/L（P<0.01）。
为确保对HBV的最佳免疫力，肾移植受者应首先根据其HBV再激活风险进行分层。来自HBV非病毒血症或病毒血症供者的肾移植受者，当其抗-HBsAb滴度<250 IU/L时应重新免疫。在其他情况下，建议临界值水平为100 IU/L。
