Self-limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30-year liver transplant program
TRANSPLANT INFECTIOUS DISEASE
Authors: Ossami Saidy, R. R.; Demir, Muenevver; Nibbe, Pauline; Dobrindt, Eva-Maria; Oellinger, Robert; Schoening, Wenzel; Pratschke, Johann; Eurich, Dennis
Abstract
Background A self-limited hepatitis B infection can reactivate in patients under immunosuppression or chemotherapy (reappearance of hepatitis B surface antigen (HBsAg) or HBV-DNA). Exact circumstances of HBV reactivation in patients undergoing liver transplantation (LT) for end-stage liver diseases (ESLD) unrelated to HBV are unknown, and recommendations on HBV prophylaxis remain unclear. Patients and methods Among 1273 liver transplants, 168 patients with a self-limited HBV hepatitis B infection prior to LT were identified from our prospective liver transplant database. Patients with underlying chronic HBV infection and recipients of an anti-HBc-positive liver were not included in the analysis. Demographic, laboratory, serological, and virological data were analyzed retrospectively. Appearance of HBsAg or HBV-DNA was defined as reactivation. Results The median follow-up after LT was 12.0 years (0.6-30.7 years). The rate of HBV reactivation was 0% independent of antiviral prophylaxis (n = 7; 4.2%), the etiology of ESLD, hepatitis C treatment, or the anti-HBs concentration. The overall patient survival with a history of a self-limited HBV infection before LT did not significantly differ from the rest of the cohort. Conclusion Antiviral treatment with nucleos(t)ide analogues post-liver transplantation in order to prevent HBV reactivation in patients with a resolved self-limited hepatitis B infection prior to LT seems to be omittable since the main viral reservoir is removed by the hepatectomy. These findings may clarify the current uncertainty in the recommendations regarding the risk of HBV reactivation in patients with self-limited hepatitis B prior to LT.
Circulating follicular helper T cells and subsets are associated with immune response to hepatitis B vaccination
HUMAN VACCINES & IMMUNOTHERAPEUTICS
Authors: Yin, Mingjuan; Xiong, Yongzhen; Huang, Lingfeng; Liu, Gang; Yu, Zuwei; Zhao, Yi; Zhao, Jie; Zhang, Yan; Lian, Tingyu; Huang, Jingxiao; Liang, DongMei; Zeng, JinMei; Ni, Jindong
Abstract
Around 5-10% of healthy vaccinees lack or produce an inadequate antibody response following receipt of a standard hepatitis B vaccination regimen. Studying immune response to hepatitis B vaccination could promote researches of immunological events contributing to this poor response. To address this, we investigated follicular helper T (Tfh) cells and firstly demonstrated similar kinetics between circulating Tfh (cTfh) cells and Tfh cells derived from mice spleen after hepatitis B vaccination. And cTfh cells were positively associated with anti-HBs at one week after vaccination (D7). Furthermore, we found PBMCs stimulated by HBsAg showed preferential activation of CXCR3(-)Tfh cells subsetsin vitro. The expression of transcription factor BCL6 in CD4(+)T cell significantly differed between D7 and four weeks after vaccination (D28). However, dynamic curve of CD19(+)B cells tended to rise then fall but no significant trends were observed. Our findings revealed a decrease in cTfh cells and subset skewing contribute to reduced antibody responses in immune response to hepatitis B vaccination, which indicated the importance of Tfh cell in facilitating the optimization of vaccine efficacy.