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June 2003 • Volume 37 • Number 6

 

 

Original Articles: Viral Hepatitis
 

Active immunization against de novo hepatitis B virus infection in pediatric patients after liver transplantation

The shortage of donor organs occasionally mandates the use of hepatic allografts from anti-HBc (+) donors. HBIG and/or lamivudine are recommended for the prevention of de novo HBV infection in naive patients, but there are attendant problems, such as mutant strain emergence and high cost. Active immunization presents a better alternative than the use of HBIG or lamivudine, if it can be proven to be effective. Accordingly, we investigated the outcome of HBV vaccination in pediatric hepatic transplant recipients. Between July 1999 and October 2001, 19 pediatric recipients were administered HBV vaccinations after liver transplantation at Seoul National University Hospital. Nine patients received a graft from anti-HBc (+) donors and 10 from anti-HBc (–) donors. When steroid was withdrawn, recombinant HBV vaccine was administered. The median follow-up period after vaccination was 10.0 ± 5.2 months. Seventeen of the 19 patients showed a positive response to vaccination. In 9 patients who received grafts from anti-HBc (+) donors, 2 patients showed no response, 4 patients low response (peak HBsAb titer <1,000 IU/L), and 3 patients high response (peak HBsAb titer 1,000 IU/L). De novo HBV infection developed in 1 of 2 patients who showed no response to vaccination. In 10 patients who received grafts from anti-HBc (–) donors, 5 showed a low response and 5 a high response. In conclusion, HBV vaccination in pediatric patients after liver transplantation appeared to exhibit some effectiveness at protecting young children that received a graft from anti-HBc (+) donors from de novo HBV infection. (HEPATOLOGY 2003;37:1329-1334.)

 

• From the ¹Department of Surgery and ²Department of Pediatrics, Seoul National University College of Medicine, Seoul; and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
• Received October 24, 2002.
   
• Accepted March 13, 2003.
• Supported by the Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
   
• Address reprint requests to: Kyung-Suk Suh, M.D., Department of Surgery, Seoul National University College of Medicine, 28 Yongon-Dong, Chongro-Gu, Seoul 110-744, Korea. E-mail: kssuh@plaza.snu.ac.kr ; fax: (82) 2-766-3975.
   
• Copyright © 2003 by the American Association for the Study of Liver Diseases.
   
• 0270-9139/03/3706-0017$30.00/0
   
• doi:10.1053/jhep.2003.50227