Donor and Recipient Hbv Immunity Before Transplantation Simultaneously Affects the Acquisition of Hbv Immunity After Unrelated-Donor Hematopoietic Stem Cell Transplantation

Abstract

Patients undergone allogeneic hematopoietic stem cell transplantation (HSCT) are accompanied by intensive chemotherapy and immunosuppression. Such patients are in high risk of hepatitis B virus (HBV) infection. Recovery of recipient immunity on HBV post-transplantation has a potential role in HBV prevention. In the current study, we performed a retrospective analysis of recipient immunity on HBV after HSCT and attempted to find out some factors associated with the HBV immunity acquisition posttransplantation. Between June 1999 and March 2009, 135 HBsAg(-) patients undergone unrelated HSCT were enrolled. HBV serum markers including HBsAg, HBeAg, HBeAb, HBsAb and HBcAb were tested for donor screen and recipients. HBV immunity was defined as positive HBsAb within 6 months posttransplantation. Patients were divided into 4 groups (R+/D+, R+/D-, R-/D+ and R-/D-; R represents recipient and D represents donor) according to + or - HBsAb in recipients and donors. The data were analyzed using spss v17.0 software. Pretransplantation characteristics of patients and donors were summarized in Table 1. Multivariate analysis showed that primary disease type, donor and recipient's sex and age, HLA disparity and conditioning regimen containing ATG were not statistically different among the 4 groups. In total 42 of 42 (100%), 22 of 32 (68.8%), 24 of 26 (92.3%) and 0 of 35 (0%) patients acquired HBV immunity posttransplantation in D+/R+, D+/R-, D-/R+ and D-/R-group respectively (p<0.05 between D+/R+ and D+/R- group, D+/R+ and D-/R- group, D+/R- and D-/R+ group, D+/R- and D-/R- group, D-/R+ and D-/R- group) indicating HBsAb in both donors and recipients had a significant favorable effect on maintaining the HBV immunity of recipients with HBsAb before transplantation. A total of 2 recipients experienced HBV reactivation posttransplantation(1 in D-/R+ and D-/R- group each) indicating HBV immunity in donors have protective effects on HBV reactivation. The mean duration from stem cell transfusion to HBsAb appearance was 25, 28, 20 and 24 days in the correspoinding group respectively (p>0.05). Our data support that donor and recipient HBV immunity before transplantation can simultaneously affect the acquisition of HBV immunity and have a vital role in HBV reactivation after unrelated-donor HSCT. HBV vaccination should be performed in both donors and recipients who have no HBV immunity before transplantation.Table 1Pretransplantation Characteristics of Patients and donors before TransplantationD+/R+ groupD+/− groupD−/R+ groupD−/R− groupp valueMedian recipient age(years)25272827>0.05Male recipient number27201621>0.05Conditioning regimen containing ATG5343>0.05Donor mean age30282931>0.05HLA mismatched5343>0.05Positive HBcAb in recipients12879>0.05Total number42322635 Open table in a new tab