Detailed Abstract
[Liver Oral Presentation 2]
[LV OP 2-4] Hepatitis B vaccination and Entecavir monotherapy following withdrawal of Hepatitis B Immunoglobulin (HBIG). An alternative approach to prevention of Hepatitis B reactivation after liver transplantation
Johann Faizal KHAN1, 2, Youngdong YU2, Hye-Sung JO2, Kyung-Chul YOON2, Woo-Hyoung KANG 2, Dong-Sik KIM2
1Hepatobiliary Surgery and Liver Transplantation, Hospital Selayang, Malaysia
2Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Korea University Medical Center, Korea
Introduction : Combination of HBIG with an oral nucleoside / nucleotide analog (Entecavir/Tenofovir) has been the mainstay of prevention of Hepatitis B reactivation after liver transplantation.. HBIG is costly, inconvenient, and may contribute to development of mutant strains. There are no consensus guidelines regarding the role of Hepatitis B vaccination in prevention of Hepatitis B reactivation after liver transplantation.
Methods : 41 liver transplant recipients on Entecavir alone were given Hepatitis B vaccination once antibody titres were undetectable. HBIG was withdrawn from all patients. The response to a standard 3 dose regimen of Hepatitis B Vaccine was evaluated. Reactivation of Hepatitis B was defined as HBsAg positive titre.
Results : Mean age was 60.54 (44-74). 27 were DDLT, 14 were LDLT. Mean BMI was 23.56 (16.27-32..47). Mean MELD score and CTP score was 15.73 and 8.56 respectively 33 patients were transplanted for Hepatitis B related HCC and 8 were for Hepatitis B related hepatic decompensation. No recurrence or adverse events occured. 34/36 (5 drop outs) patients had undetectable HBsAb titres. 9 patients had positive response to vaccination. 2 patients had persistent antibody titres (not vaccinated). 1 patient responded after a fourth dose. 2 patients had no response even after 4 doses and 1 no response after 6 doses. A significant positive response to vaccination was seen in patients receiving single immunosuppressive agent compared to a combination (p=0.048)
Conclusions : A standard 3 dose Hepatitis B Vaccination regime may confer additional immunity. Patients who are on single immunosuppressive agent are more likely to develop a positive response to vaccination.
Methods : 41 liver transplant recipients on Entecavir alone were given Hepatitis B vaccination once antibody titres were undetectable. HBIG was withdrawn from all patients. The response to a standard 3 dose regimen of Hepatitis B Vaccine was evaluated. Reactivation of Hepatitis B was defined as HBsAg positive titre.
Results : Mean age was 60.54 (44-74). 27 were DDLT, 14 were LDLT. Mean BMI was 23.56 (16.27-32..47). Mean MELD score and CTP score was 15.73 and 8.56 respectively 33 patients were transplanted for Hepatitis B related HCC and 8 were for Hepatitis B related hepatic decompensation. No recurrence or adverse events occured. 34/36 (5 drop outs) patients had undetectable HBsAb titres. 9 patients had positive response to vaccination. 2 patients had persistent antibody titres (not vaccinated). 1 patient responded after a fourth dose. 2 patients had no response even after 4 doses and 1 no response after 6 doses. A significant positive response to vaccination was seen in patients receiving single immunosuppressive agent compared to a combination (p=0.048)
Conclusions : A standard 3 dose Hepatitis B Vaccination regime may confer additional immunity. Patients who are on single immunosuppressive agent are more likely to develop a positive response to vaccination.
SESSION
Liver Oral Presentation 2
Room C 4/5/2019 11:21 AM - 11:28 AM