Development of antibody to hepatitis B surface antigen after liver transplantation for chronic hepatitis B

Authors

  • Chung-Mau Lo,

    Corresponding author
    1. Department of Surgery, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
    • Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China. Fax: (852) 28175475
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  • James Tak-Kwan Fung,

    1. Department of Surgery, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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  • George Ka-Kit Lau,

    1. Department of Medicine, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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  • Chi-Leung Liu,

    1. Department of Surgery, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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  • Siu-Tim Cheung,

    1. Department of Surgery, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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  • Ching-Lung Lai,

    1. Department of Medicine, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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  • Sheung-Tat Fan,

    1. Department of Surgery, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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  • John Wong

    1. Department of Surgery, Center for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
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Abstract

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.

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