| Theme | Liver Transplantation -- Current Status and Perspective | |
|---|---|---|
| Title | Liver Transplantation for HBV-related Liver Disease | |
| Publish Date | 2013/08 | |
| Author | Takashi Onoe | Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University / Institute for Clinical Research, National Hospital Organization, Kure Medical Center / Chugoku Cancer Cent |
| Author | Shoichi Takahashi | Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University |
| Author | Kazuaki Chayama | Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University |
| Author | Hideki Ohdan | Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University |
| [ Summary ] | Liver transplantation (LT) is highly effective for patients with end-stage hepatitis B virus (HBV)-related liver disease. Nonetheless, HBV infections often recur after LT without prophylaxis. Currently, a combination therapy involving a nucleotide analog and hepatitis B immunoglobulin (HBIG) has been established as the standard prophylaxis for post-LT HBV reinfection. It has been shown to provide marked improvements in patient survival rates. This prophylactic therapy has also been shown to be effective for treatment of de novo hepatitis B in recipients who have received grafts from HBcAb-positive donors. However, the regimen presently varies from institute to institute and a standardized regimen remains to be established. Because this prophylactic regimen is costly and does not guarantee safety after long-term use, active immunization with an HBV vaccine post-LT is a preferable alternative. However, it has been reported that patients showed poor response to vaccinations because of the immunosuppressive environment (response rate：approximately 10 %) induced post-LT. We scheduled mixed-lymphocyte reaction assays to monitor patientsʼ immune status and to minimize immunosuppression, and performed unlimitedly repeated vaccinations. The overall response rate for vaccinations was 65 %. Patients who exhibited responses were safely weaned off HBIG and/or nucleotide analogs in our institute. Thus, minimizing immunosuppression to induce an antidonor-specific immunosuppressive status should enable post-LT HBV vaccinations to become a promising prophylactic strategy. |
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