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Development of antibody to hepatitis B surface antigen after liver transplantation for chronic hepatitis B
Author(s) -
Lo ChungMau,
Fung James TakKwan,
Lau George KaKit,
Liu ChiLeung,
Cheung SiuTim,
Lai ChingLung,
Fan SheungTat,
Wong John
Publication year - 2003
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2003.50035
Subject(s) - hbsag , medicine , seroconversion , lamivudine , liver transplantation , transplantation , hepatitis b , hepatitis b virus , gastroenterology , immunology , titer , antibody , virus
Patients with chronic hepatitis B virus (HBV) infection have a defective HBV‐specific immune response, and the spontaneous development of antibody against hepatitis B surface antigen (anti‐HBs) after liver transplantation has not been observed. We report the spontaneous production of anti‐HBs in 21 of 50 (42%) patients receiving lamivudine monoprophylaxis after liver transplantation. Seroconversion to anti‐HBs status (>10 mIU/mL) was found at a median of 8 days (range, 1 to 43 days) after transplantation. In each case, serial serum samples showed a >100% increase in antibody titer as compared with that of day 7 after transplantation in the absence of any blood product transfusion. The anti‐HBs titer increased to a maximum within 3 months, and the peak titer was <100 mIU/mL in 10 patients, 100 to 1000 mIU/mL in 5 patients, and >1,000 mIU/mL in 6 patients. In 12 patients, anti‐HBs disappeared from serum at a median of 201 days (range, 24 to 414 days), whereas the other 9 patients remained positive for anti‐HBs at a median of 221 days (range, 94 to 1,025 days) after transplantation. Patients in whom anti‐HBs in serum developed had a more rapid clearance of serum hepatitis B surface antigen (HBsAg) (log rank test, P = .011). Using logistic regression analysis, the only predictor of anti‐HBs production was an HBV‐immune donor (odds ratio, 18.9; 95% confidence interval, 3.2 to 112.4; P = .001). In conclusion, patients who undergo liver transplantation for chronic hepatitis B using lamivudine prophylaxis may develop anti‐HBs spontaneously. The antibody is likely to be of donor origin, suggesting the possibility of adoptive immunity transfer through a liver graft.