Enhancing active immunity against hepatitis B virus by HBV vaccine immunization in patients with HBV-related end-stage liver diseases treated with liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To study the active immunity response of liver transplant patients for HBV-related diseases after hepatitis B virus (HBV) vaccine immunization and to investigate the factors that influence the effectiveness of the vaccination in order to find measures to increase its success.</p><p><b>METHODS</b>Thirteen patients who had liver transplants because of HBV-related end-stage liver diseases received hepatitis B virus immunoglobulin and lamivudine for an average of 38 months (range 27-77 months). They received double intramuscular doses (40 microg) of a recombinant vaccine at months 0, 1, 2 and 6. The anti-HBs titers were tested regularly at months 1, 2, 3, 6 and 7.</p><p><b>RESULTS</b>Seven of the 13 patients (53.8%) developed higher serum titers of anti-HBs compared with their titers prior to the vaccinations, 2 patients of the 13 (15.4%) developed an increase by 100 U/L and in 4 patients (30.8%) their base levels were doubled. Those responding patients were followed-up for another 8 months after the fourth vaccination, and only 1 patient among them had a decrease of the anti-HBs titers below the level prior to the vaccination.</p><p><b>CONCLUSION</b>Hepatitis B vaccine immunization can be used to enhance the active immunity against HBV in patients who had liver transplants for HBV-related diseases.</p>

An analysis of long term prophylaxis of virus recurrence with antiviral treatment in HBV infected liver transplant recipient patients / 中华肝脏病杂志

<p><b>OBJECTIVE</b>No optimal prophylactic protocol of hepatitis B immunoglobulin (HBIG) combined with nucleos(t)ide analogue for HBV recurrence has been established yet. By investigating the alterations of HBV markers in HBV related liver disease patients, recipients of a liver transplant, under lamivudine or/and HBIG prophylaxis, we aim to explore the possible HBV recurrence mechanism involved and to find a new option in the prophylaxis of HBV recurrence and to tailor individualized therapy.</p><p><b>METHODS</b>Serial liver biopsy specimens and sera were obtained intraoperationally and at definite time points during follow-up. ELISA and chemiluminescent microparticle immunoassay, HBV DNA fluorescent quantification, immunohistochemistry staining and HBV DNA in situ hybridization were performed. Alterations of HBV markers in specimens of 96 liver transplant recipients were investigated retrospectively.</p><p><b>RESULTS</b>All 17 cases had HBV recurrence (median 37 months) which occurred in the follow-up period after liver transplantation. The overall actual HBV recurrence rate at 2 years was 22% with a significant difference between that of the active and inactive groups (P<0.05); 82.4% HBV recurrence took place within the first 3 years after the operation, and the recurrence ratio of first 3 years to 3 years later after transplantation was 4.7 (P<0.01). The HBV DNA positive patients accounted for 78.6% of the total number of recurrences within the first 3 years. HBcAb and HBeAb positive rates went down with time, but their positivity remained.</p><p><b>CONCLUSION</b>HBV recurrence happens after liver transplantation. In inactive HBV replicative patients with strictly combined prophylaxis and availability of other medications and using 3 years after liver transplantation as a point of time, we think that tapering down the dosage of HBIG and tailoring individualized treatment methods based on virological and immunological situations of each recipient are worth trying.</p>