LONG-TERM FOLLOW-UP OF ACITVE IMMUNIZATION AGAINST DE NOVO HEPATITIS B VIRUS INFECTION IN PEDIATRIC PATIENTS AFTER LIVER TRANSPLANTATION

Abstract

O98* Aims: The shortage of donor organs occasionally mandates the use of hepatic allografts from anti-HBc (+) donors. Active immunization presents a better alternative than the use of HBIG or lamivudine for the prevention of de novo HBV infection in naive patients, because there are attendant problems such asd mutant strain emergence and high cost. Accordingly, we recently reported the outcome of HBV vaccination in pediatric hepatic transplant recipients. The aim of this study was to investigate the long-term outcome of active immunization in these pediatric patients Methods: 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 When steroid was withdrawn, recombinant HBV vaccine was administered. During the follow up period, booster was administered at 12–36 months postoperatively, one or two times. The median follow up period after vaccination was 37.2 ± 5.0 (range 29–46) months. Results: Eighteen of the 19 patients showed a positive response to vaccination. In 9 patients who received grafts from anti-HBc (+) donors, one patient showed no response, 5 patients low response (peak HBsAb titer < 1000 IU/L), and 3 patients high response (peak HBsAb titer ≥ 1000 IU/L). De novo HBV infection developed in one patient who showed no response to vaccination. In 10 patients who received grafts from anti-HBc (−) donors, 6 showed a low response and 6 a high response. Conclusions: HBV vaccination in pediatric patients after liver transplantation appeared to be effective at protecting patients that received a graft from anti-HBc (+) donors from de novo HBV infection.