Ikeda Ailee, Takaki Akinobu, Yasunaka Tetsuya, Oyama Atsushi, Adachi Takuya, Wada Nozomu, Onishi Hideki, Ikeda Fusao, Shiraha Hidenori, Yoshida Kazuhiro, Kuise Takashi, Nobuoka Daisuke, Yoshida Ryuichi, Umeda Yuzo, Yagi Takahito, Fujiwara Toshiyoshi, Okada Hiroyuki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Acta Med Okayama. 2019 Feb;73(1):41-50. doi: 10.18926/AMO/56457.
Post-orthotopic liver transplantation (OLT) hepatitis B recurrence is well-controlled with a nucleos(t)ide analogue and hepatitis B immunoglobulin (HBIG) combination, but the high cost and the potential risk of unknown infection associated with HBIG remain unresolved issues. Low-cost recombinant hepatitis B virus (HBV) vaccine administration is a potential solution to these problems. We retrospectively analyzed the rate and predictive factors of HBV vaccine success in 49 post-OLT patients: liver cirrhosis-type B (LC-B), n=28 patients; acute liver failure-type B (ALF-B), n=8; and non-HBV-related end-stage liver disease (non-B ESLD) who received a liver from anti-hepatitis B core antibody-positive donors, n=13. A positive anti-hepatitis B surface antibody response was achieved in 29% (8/28) of the LC-B group, 88% (7/8) of the ALF-B group, and 44% (4/9) of the adult non-B ESLD group. All four non-B ESLD infants showed vaccine success. The predictive factors for a good response in LC-B were young age, marital donor, and high donor age. ALF-B and non-B ESLD infants are thus good vaccination candidates. LC-B patients with marital donors are also good candidates, perhaps because the donated liver maintains an efficient immune memory to HBV, as the donors had already been infected in adulthood and showed adequate anti-HBV immune responses.
原位肝移植（OLT）后乙肝复发可通过核苷（酸）类似物与乙肝免疫球蛋白（HBIG）联合用药得到良好控制，但HBIG的高成本以及与之相关的未知感染潜在风险仍是尚未解决的问题。低成本的重组乙肝病毒（HBV）疫苗接种是解决这些问题的一个潜在办法。我们回顾性分析了49例OLT术后患者的HBV疫苗接种成功率及预测因素：B型肝硬化（LC-B）患者28例；急性肝衰竭B型（ALF-B）患者8例；以及接受来自抗乙肝核心抗体阳性供体肝脏的非HBV相关终末期肝病（非B型ESLD）患者13例。LC-B组29%（8/28）、ALF-B组88%（7/8）以及成年非B型ESLD组44%（4/9）的患者出现了抗乙肝表面抗体阳性反应。所有4例非B型ESLD婴儿均接种成功。LC-B组接种反应良好的预测因素为年龄小、配偶供体以及供体年龄大。因此，ALF-B和非B型ESLD婴儿是良好的疫苗接种对象。配偶为供体的LC-B患者也是良好对象，可能是因为所捐赠的肝脏对HBV保持了有效的免疫记忆，因为供体在成年期已被感染并表现出足够的抗HBV免疫反应。
