Iwata Kentaro, Ikegaki Shunkichi, Hyodo Yoji, Miyake Hideaki
Division of Infectious Diseases, Kobe University Hospital, Kobe, Hyogo, Japan.
Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Clin Transplant. 2025 Sep;39(9):e70307. doi: 10.1111/ctr.70307.
Hepatitis B vaccination is recommended for those receiving kidney transplants. When hepatitis B surface antibody (HBsAb) levels remain low, the booster dose of the vaccine should be considered. Some consider that the use of a different product as a booster might be beneficial to the patients, but the effectiveness of such a strategy has not been evaluated.
The kidney transplant recipients (KTR) who received hepatitis B vaccines (Bimmugen or Heptavax-II), and failed to develop enough antibody titer and those who received additional vaccines, were enrolled in the study. Those who received a different product were compared with those who received the same product as the booster. The outcome is the seroconversion of hepatitis B surface antibody level ≧ 10 IU/mL.
A total of 26 patients were non-responders after a receipt of three-dose hepatitis B vaccines. Among those, 15 received additional hepatitis B vaccine of the different product (crossover group), and 11 received the same product (non-crossover group). Only five patients (19.2%) had seroconversion after the booster doses, three in the crossover group (20%) and two in the non-crossover group (18.2%) (p = 1.0). In the Bayesian analysis, the medial posterior probability of the seroconversion rate of the crossover group was 23% (95% CrI: 7%-47%), whereas that of the non-crossover group was 14% (95% CrI: 2%-40%).
The crossover strategy hepatitis B vaccines did not appear to lead to seroconversion of much significance among KTR. Other options to augment the protection should be investigated to protect these populations against the infection.
建议接受肾移植的患者接种乙肝疫苗。当乙肝表面抗体（HBsAb）水平持续较低时，应考虑接种疫苗加强针。一些人认为使用不同产品作为加强针可能对患者有益，但尚未评估这种策略的有效性。
纳入接受乙肝疫苗（Bimmugen或Heptavax-II）但未产生足够抗体滴度的肾移植受者（KTR）以及接受额外疫苗的患者。将接受不同产品加强针的患者与接受相同产品加强针的患者进行比较。观察指标为乙肝表面抗体水平≥10 IU/mL的血清学转换。
共有26例患者在接种三剂乙肝疫苗后无应答。其中，15例接受了不同产品的额外乙肝疫苗（交叉组），11例接受了相同产品（非交叉组）。加强针接种后仅有5例患者（19.2%）发生血清学转换，交叉组3例（20%），非交叉组2例（18.2%）（p = 1.0）。在贝叶斯分析中，交叉组血清学转换率的中位后验概率为23%（95% CrI：7%-47%），而非交叉组为14%（95% CrI：2%-40%）。
在肾移植受者中，交叉策略的乙肝疫苗似乎并未导致显著的血清学转换。应研究其他增强保护的方法，以保护这些人群免受感染。
