Active Immunization for Prevention of De Novo Hepatitis B Virus Infection After Adult Living Donor Liver Transplantation With a Hepatitis B Core Antigen-Positive Graft

De novo hepatitis B virus (DNHB) infections may occur in recipients who do not receive prophylaxis after liver transplantation (LT) with antibody to hepatitis B core antigen (anti-HBc)-positive donor grafts. Active immunization has been shown to prevent DNHB in pediatric recipients. Our aim is to investigate the efficacy of HBV vaccination for preventing DNHB in adult living donor liver transplantation (LDLT). In total, 71 adult antibody to hepatitis B surface antigen (anti-HBs)-negative LDLT patients who received anti-HBc+grafts from 2000 to 2010 were enrolled into this study. Patients were given hepatitis B virus vaccinations with the aim of achieving anti-HBs>1000 IU/L before transplant and >100 IU/L after transplant. The cohort was stratified into 3 groups: patients with pretransplant anti-HBs titer of>1000 IU/L without the need for posttransplant prophylaxis (group 1, n=24), patients with pretransplant low titer of <1000 IU/L who were given posttransplant lamivudine prophylaxis and responded appropriately to posttransplant vaccination by maintaining anti-HBs titers of>100 IU/L (group 2, n=30), and low titer nonresponders (anti-HBs titer of<100 IU/L despite vaccination), for whom lamivudine was continued indefinitely (group 3, n=17). All DNHB occurred in group 3 patients with posttransplant anti-HBs levels of<100 IU/L, with an incidence rate of 17.6% compared with 0% in patients with posttransplant anti-HBs levels of>100 IU/L (P=0.001). A pretransplant anti-HBs level of >1000 IU/L was significantly associated with early attainment and a sustained level of posttransplant anti-HBs of >100 IU/L (P<0.001). Active immunization is effective in preventing DNHB in adult LDLT if the posttransplant anti-HBs level is maintained above 100 IU/L with vaccination. Antiviral prophylaxis can be safely discontinued in patients who obtain this immunity.